IntroductionPrevious studies have shown an association between gout and/or hyperuricemia and a subsequent increase in cardiovascular disease (CVD) outcomes. Allopurinol reduces vascular oxidative stress, ameliorates inflammatory state, improves endothelial function, and prevents atherosclerosis progression. Accordingly, we tested the hypothesis that a positive association between allopurinol therapy in gout patients and future cardiovascular outcomes is present using a population-based matched-cohort study design.MethodsPatients aged ≥40 years with newly diagnosed gout having no pre-existing severe form of CVD were separated into allopurinol (n = 2483) and non-allopurinol (n = 2483) groups after matching for age, gender, index date, diabetes mellitus, hypertension, hyperlipidemia, and atrial fibrillation. The two groups were also balanced in terms of uric acid nephrolithiasis, acute kidney injury, hepatitis, and Charlson comorbidity index.ResultsWith a median follow-up time of 5.25 years, the allopurinol group had a modest increase in cardiovascular risk [relative risk, 1.20; 95% confidence interval (CI), 1.08–1.34]. A Cox proportional hazard model adjusted for chronic kidney disease, uremia, and gastric ulcer gave a hazard ratio (HR) for cardiovascular outcomes of 1.25 (95% CI, 1.10–1.41) in gout patients receiving allopurinol compared with the non-allopurinol group. In further analysis of patients receiving urate-lowering therapy, the uricosuric agent group (n = 1713) had an adjusted HR of 0.83 (0.73–0.95) for cardiovascular events compared with the allopurinol group.ConclusionsThe current population-based matched-cohort study did not support the association between allopurinol therapy in gout patients with normal risk for cardiovascular sequels and beneficial future cardiovascular outcomes. Several important risk factors for cardiovascular disease, such as smoking, alcohol consumption, body mass index, blood pressure were not obtainable in the current retrospective cohort study, thus could potentially bias the effect estimate.

home, obtained at least 4 home BP measurements, and returned the home BP measurement device for analysis Results: Of 132 participants enrolled, 93 (70%) returned the home BP measurement device and had at least 4 home BP measurements. Of the 93 participants analyzed, their median age was 40 years old ; 54% were female, 23% were Black, and 61% were White. Those meeting the HTN diagnosis threshold based on home BP measurements as stratified by BpTRU ED BP were: Pre-HTN (systolic BP 120-139 or diastolic BP 80-89) (n¼39): 31% (95% CI: 17-48); Stage I HTN (systolic BP 140-159 or diastolic BP 90-99) (n¼38): 50% (95% CI: 33-67); and Stage II HTN (systolic BP ! 160 or diastolic BP ! 100) (n¼25): 75% (95% CI: 48-93).Conclusions: In this feasibility study, we found that home BP monitoring after ED discharge could be a valuable tool to confirm a HTN diagnosis, particularly for ED patients with higher in-ED BP measurements. However, interventions to maximize the return of home BP monitors appear necessary to make this practice a viable option. ED-based HTN screening coupled with home BP monitoring may help reduce rates of untreated and undiagnosed HTN.Study Objectives: Diltiazem is a frequent pharmacological treatment for atrial fibrillation (AF) with rapid ventricular response (RVR) in the ED. The most common dosing is an intravenous (IV) bolus followed by a continuous infusion. An IV bolus followed by oral diltiazem might reduce treatment cost and adverse events. The primary study objective was to test the safety and efficacy this IV then oral approach compared to a bolus and infusion approach.Methods: This was a multicenter, retrospective cohort study. The setting was 6 academic and community EDs. We included patients who received oral or continuous infusion of diltiazem following an initial IV loading dose for treatment of AF with RVR. We excluded patients with a presenting pulse rate < 120 beats/min and those who received other concomitant antiarrhythmic drugs. The primary outcome was assessed by need for additional IV boluses of rate control medications for rescue therapy. Secondary outcomes included administration of vasopressors for treatment associated hypotension and hospital length-of-stay.Results: Over a 30-month period, there were 1867 eligible patients. There were 1651 in the bolus + infusion group and 216 in the bolus + oral diltiazem group. New-onset AF was present in 31.8%. Rescue medications were required for rate control in 24.5% of patients, and 3.4% required a vasopressor for treatment associated hypotension. The rate of rescue treatment for rate control was not significantly different between the oral diltiazem (27.8%) and infusion (24.1%) groups (OR 1.2, 95% CI 0.9 -1.7). Patients with new-onset AF were more likely to require rescue therapy (OR 1.4, 95% CI 1.1 -1.7). There was a significantly higher rate of vasopressor treatment in the infusion (3.7%) compared to the oral diltiazem cohort (0.9%), OR 4.1 (95% CI 1.0 -16.9). Patients who required rescue therapy had double the rate of vasopressor treatment...