Diagnostic accuracy of office blood pressure compared to home blood pressure in patients with mild cognitive impairment and dementia.
Rianne Aa de Heus, Maxime V Tumelaire, Marcel Gm Olde Rikkert and 1 others
PMID 31262187WHAT IT FOUND
In older memory clinic patients, office BP and home BP disagreed on hypertension diagnosis in 31%.
Disagreement was 35.4% in dementia and 38.5% in mild cognitive impairment, versus 18.2% in patients without cognitive impairment.
Key findings
01Office and home BP disagreed on hypertension diagnosis in 31% of patients.
02Disagreement was 35.4% in dementia, 38.5% in MCI, and 18.2% in cognitively normal patients.
03White-coat hypertension was 20.7% in dementia, 33.8% in MCI, and 13.6% in cognitively normal patients; masked hypertension was 14.6% in dementia, 4.6% in MCI, and 4.5% in cognitively normal patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only patients willing to do home BP were studied, and they had higher office systolic BP, fewer women, and less dementia than non-participants, so results may not apply to all memory clinic patients. The final analysis used 213 patients because 23 of 236 who completed enough home measurements had no office BP in the record. Office BP was manual and taken by different physicians as routine care, so observer differences could affect results. Home BP was used as the reference standard, but it cannot be ruled out that home BP itself caused some disagreement. Adherence to home BP instructions, such as resting before measurement and avoiding food or medication shortly before, could not be ensured. The cross-sectional design cannot show which measurement predicts outcomes or guides treatment benefit.
The easy way to misread this
Do not conclude that using home BP has been shown to improve patient outcomes. This study only compared office and home BP diagnosis in memory clinic patients; it did not test treatment decisions or follow outcomes.