Elevated blood pressure (BP) is reported in many individuals without hypertension presenting to the emergency department (ED). Whether this condition represents a transient state or is predictive for the development of future hypertension is unknown. This observational prospective study investigated patients admitted to an ED without a diagnosis of hypertension in whom BP values were ≥140/90 mm Hg. The primary outcome was development of hypertension during follow-up. Overall, 195 patients were recruited and at the end of follow-up (average 30.14AE15.96 months), 142 patients were diagnosed with hypertension (73% Admission to the emergency department (ED) is certainly a stressful situation. Many patients without a diagnosis of hypertension admitted to the ED with various etiologies have blood pressure (BP) >140/90 mm Hg.1 Possible causes for this increment in BP in the ED setting is pain and anxiety. On the other hand, other patients with the same pain and anxiety level do not have increased BP. This increase of BP in the ED setting may be viewed as a form of white-coat hypertension, an entity associated with the future development of hypertension.2-6 Yet, it is unclear whether patients with high BP values recorded in the ED setting are also at increased risk for the development of future hypertension. We conducted a prospective study in which patients without a history of hypertension in whom BP measurements recorded in the ED were ≥140/ 90 mm Hg were followed for the development of hypertension. METHODS Study PopulationThis was an observational prospective study in which patients aged 18 to 80 years admitted to the ED of Rabin Medical Center were evaluated. Rabin Medical Center is a tertiary center located in central Israel and its ED is the third largest in Israel, with more than 150,000 annual visits. The study population included patients without a previous diagnosis of hypertension and with a discharge diagnosis of elevated BP in the years 2009 to 2010. Hypertension was defined by a persistent record of elevated office BP values ≥140/90 mm Hg, an average BP >135/85 mm Hg on ambulatory BP monitoring, or treatment with antihypertensive medications. Patients were followed prospectively until May 2014. The study was approved by the Rabin Medical Center institutional review board. Inclusion and Exclusion CriteriaPatients were included if they were aged 18 to 80 years without a prior diagnosis of hypertension in which BP recorded in the ED was ≥140/90 mm Hg. Patients with a prior diagnosis of primary or secondary hypertension were excluded from the study. A history of hypertension was excluded when "hypertension" was not listed as one of the chronic medical problems in the patient's medical file, when persistent office BP values ≥140/90 mm Hg or an average BP >135/85 mm Hg on ambulatory BP monitoring were not recorded, and when antihypertensive medications were not dispensed prior to the ED visit.BP Measurement and Data Collection BP measurement was performed by a nurse or a physician with the patient in a sitting...

Subjective outcomes may exaggerate intervention effects compared to objectively measured outcomes. We compared effect estimates for clinical failure and all-cause mortality clinical trials of antibiotic treatment for pneumonia. A systematic review of randomized controlled trials assessing adults with pneumonia, comparing different antibiotics, published between 2005 and 2012 was undertaken. We compared the intervention to the control arm. The all-cause mortality in the intention-to-treat population and clinical failure as defined by the study investigators for the primary analyzed population were the primary outcomes examined. Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled, using a fixed effect model. Meta-regression was used to examine the impact of clinical failure on the mortality effect size. Thirty-six trials were included, of which 30 were industry-sponsored and 30 were non-inferiority trials. There was no difference between the effect on mortality for intervention versus control (RR 1.02, 95 % CI 0.91-1.16) and clinical failure (RR 1.01, 95 % CI 0.93-1.10), without significant heterogeneity in both analyses. In double-blind trials with adequate sequence generation and concealment, there was a significant advantage to the intervention for clinical failure (RR 0.86, 95 % CI 0.76-0.98), but not for mortality (RR 0.96, 95 % CI 0.76-1.21). RRs for clinical failure did not explain the variability in the RRs for mortality significantly, with a meta-regression coefficient of 0.32 (95 % CI -0.21-0.85). In non-inferiority trials of antibiotic treatment for pneumonia, we did not find evidence for bias induced by the use of a subjective outcome overall. The small number of trials without sponsorship precludes an adequate assessment of sponsorship effects.

BAV in young healthy subjects may influence cardiac morphology irrespective of the presence of aortic regurgitation. Aeromedical disposition for patients with BAV should be based on the presence of the condition and not on the presence of AR, considering the AR is of a mild or minimal degree.