Something a bit different for the September 2015 #GeriMedJC

Did you know that the live version of the Geriatric Medicine Journal Club held at the University of Toronto, is on the last Friday of the month from 08:00-09:00 ET?  Postgraduate subspecialty trainees in Geriatric Medicine take turns leading the critical appraisal.  Article selection is guided by a clinician-scientist.  The first 45 minutes of the hour is devoted to the presentation and discussion of the long article and the latter 15 minutes is reserved for presentation and appraisal of the short article. The live version is also broadcast to several different hospitals in several different cities via the Ontario Telemedicine Network.

#GeriMedJC, the Twitter-complement to the traditional format journal club, has been up and running for over a year.  The intention is to engage an international dialogue across all time zones as a tweetchat should have no time restrictions.  

We obtained feedback about the first year's experience from our postgraduate trainees and faculty. One of the challenges was hesitancy to engage on the Twitter medium due to unfamiliarity with Twitter. However, there was recognition and appreciation for #GeriMedJC to engage international experts and dialogue. Therefore, in the September 2015 live version of #GeriMedJC, we will be devoting the first half of the hour on how to get started on using Twitter for journal clubs as well as tips for the advanced tweep.  In the meantime, check out our cool new infographic, How to #GeriMedJC. Another feedback suggestion was to have a repository of the previous articles and transcripts of the tweet chats much like the #RheumJC and #NephJC folks.  Look out for our new #GeriMedJC website which is under construction!  

Since the first half of the hour of this month's live #GeriMedJC will be devoted to How to #GeriMedJC, the critical appraisal of the short article will commence at 08:30 ET / 12:30 GMT. 

The association between blood pressure and cognitive function remains controversial with studies showing mixed results.  This may yet be another example of 'not one size fits all'. People are individuals, not numbers.

Mossello E, Pieraccioli M, Nesti N, Bulgaresi M, Lorenzi C, Caleri V, Tonon E, Cavallini MC, Baroncini C, Di Bari M, Baldasseroni S, Cantini C, Biagini CA, Marchionni N, Ungar A.Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015 Apr;175(4):578-85. 

PMID: 25730775

Access the article here or read the abstract below:

IMPORTANCE:
The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized.

OBJECTIVE:
To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI).

DESIGN, SETTING, AND PARTICIPANTS:
Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics.

MAIN OUTCOMES AND MEASURES:
Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up.

RESULTS:
We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change.

CONCLUSIONS AND RELEVANCE:
Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

Can't join us live? No worries!  Engage in the discussion on Twitter on August 28, 2015 at 08:00 ET / 12:00 GMT and don't forget to use the hashtag #GeriMedJC.