Circadian Hyper-amplitude-tension Research Articles

PS-C23-1: EFFECT OF OMEGA3,6,9 BLENDED OIL ON CIRCADIAN VARIATIONS OF AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND CAD

Flaxseed oil is considered to be a rich source of Alpha-Linolenic Acid(ALA), along with Lignans, fibers, protein, vitamins,s, and minerals. A number of studies have proved the beneficial role of ALA, EPA, and DHA found in flaxseed on health. Besides providing nutrition, they have anti-inflammatory, antihypertensive and cardioprotective properties. However pure flaxseed oil does not have oxidative stability due to which it could not be stored for long-term edible use. The blending process can be an alternative method for Partial hydrogenation, therefore we used this process to reduce the percentage of unsaturated linoleic and linolenic acids of Flaxseed oil with Palm oil in a stabilized ratio which helps in maintaining the overall oxidative stability and proper ratio of Omega 3, omega 6 and omega 9 content in the Blended product. Aim of this study was to access the effect of blended flaxseed oil on 24 hour seven day circadian variations of blood pressure in subjects with essential hypertension. Many Studies have proved that Chronobiological analysis of blood pressure by four to Seven-day continuous ambulatory blood pressure monitoring and assessment of CHAT (circadian hyper amplitude tension) is the best marker for cardiovascular function. We registered 100 subjects with Coronary Artery Disease (Group1) and Essential hypertension (Group2) and 100 control subjects with CAD/ Hypertension. Group 1 and 2 participants were supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of six months while the control group was not given any BFO (They were using their routine edible oil). Twenty-four hour seven days continuous ambulatory blood pressure monitoring was done initially, after three months and after six months of supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that optimized doses of blended flaxseed oil have the required amount of ALA and essential fatty acids as per guidelines of AHA, Blended flaxseed oil administration can be a potent antihypertensive and helps in the synchronization of cardiac rhythms, and an effective vegetarian source in maintaining Omega 3 and omega 6 ratios.

CIRCADIAN VARIABILITY AND CIRCADIAN HYPER AMPLITUDE TENSION AS A EARLY PREDICTIVE MARKER OF CHEMOTHERAPHY INDUCED CARDIOTOXICITY

Objective: Chemotherapeutic Medicines like Anthracycline antibiotics are effectively being used for breast cancer treatment in India. Despite of close clinical monitoring, the use of serological markers, such as troponins and BNP, and finally by using standard and novel imaging techniques like, nuclear imaging, echocardiograms etc some patients still develop severe left ventricular dysfunction. Also there are certain limitations of these techniques as these techniques can predict CV damages only after Cardiac function deterioration has become irreversible. Design and method: Therefore in this study Seven day continuous ambulatory blood pressure monitoring and CHAT (circadian hyper amplitude tension) have been evaluated to find out the variability in blood pressure and heart rate as a marker for cardiac function. Subjects who were fulfilling the inclusion criteria were enrolled for study. 24 hour /7days Ambulatory blood pressure monitoring, Left ventricular Ejection Fraction ratio (LVEF), Heart rate variability (HRV) and Cardiotoxicity Biomarkers viz Brain Natruitic peptide (BNP) and C- Reactive Protein (Hs CRP) and Troponin T were analyzed before receiving first Cycle of Antracycline Chemotherapy. All the parameters were repeated after first and Second Cycle of Chemotherapy. Results: Results shows significant increase in MESOR and Double Amplitude and Hyperbaric indexes of SBP, DBP and HR after Chemotherapy. Number of subjects diagonosed with CHAT (Circadian Hyper Amplitude Tension) increased after Chemotherapy while No Significant Changes were noted in LVEF (Left Ventricular ejection fraction) and serum biomarkers (i.e Troponin T, Hs CRP, and BNP). These data suggest that Anthracyclines Chemotheraphy treatment in Breast Cancer Subjects produces variations in 7 day circadian pattern of blood pressure and heart rate which can result into disturbed vascular events and thus are at greater risk of cardiovascular morbidity. Conclusions: long term monitoring of circadian pattern of blood pressure and heart rate in cancer patients will be an effective measure to prevent chemotherapy induced cardiotoxicity. Chronobiological screening parameters will be a novel approach in the context of chemotherapy induced cardiotoxity in order to identify or stratify risk in cancer patients that would potentially benefit from early cardio protective or other precautionary measures.

Effect of essential fatty acid blend on circadian variations of ambulatory blood pressure in patients with essential hypertension and coronary artery disease risk markers.

Flaxseed oil is an excellent source of alpha-linolenic acid ALA known for its antihypertensive action. Flaxseed oil is unstable and its dose is not achievable in our conventional diet hence blending of natural flaxseed oil with palm oil, containing high flavonoids may be a better strategy, to stabilize the blend and provide proper balance of essential fatty acids and potential antioxidant effects. Aim of this study was to access the effect of blended flaxseed oil on 24 h 7-day circadian variations of blood pressure in subjects with essential hypertension. Assessment of CHAT (circadian hyper amplitude tension) using ABPM is the best marker for cardiovascular function. We registered 50 subjects with CAD (Group 1) and 50 subjects with Essential hypertension HT (Group 2) and 52 control subjects with CAD/Hypertension. Group 1 and 2 participant was supplemented with blended flaxseed oil (BFO) (30 ml/day) for the period of 24 weeks, while control group administered available oils sunflower in identical containers, for a follow-up period of 24 weeks. Twenty four hour seven days continuous ambulatory blood pressure monitoring was done initially and after six months of BFO supplementation. There were significant changes noted in lipid profile along with Ambulatory blood pressure parameters like MESOR, ACROPHASE, Hyperbaric Indexes, and CHAT. Circadian hyper amplitude tension (CHAT) incidence decreased after BFO supplementation. Study results suggest that blended flaxseed oil administration can be a potent natural vegetarian antihypertensive supplement which helps in synchronization of cardiac rhythms, and can be used as a preventive treatment of hypertension and as effective vegetarian source of maintaining Omega 3 and omega 6 ratios of essential fatty acids in the body.

ВЛИЯНИЕ ИЗБЫТОЧНОЙ МАССА ТЕЛА НА ПОКАЗАТЕЛИ СУТОЧНЫХ РИТМОВ ГЕМОДИНАМИКИ

In terms of the attributable number of deaths, the main risk factor for non-communicable diseases globally is hypertension, obesity and obesity follow it in importance. In this study we studied the influence of body mass index indices on the circadian rhythms of the basic parameters of the hemodynamics. Practically healthy volunteer students of both sexes (N = 78), aged 17 to 27, with an average age of 20.7 ± 2.78 years, predominantly Kazakh ethnicity (97%) took part in the studies. Students with normal body mass index (BMI) in this age group are about 66% of the studied population, also we identified students with insufficient body weight (deficiency), with a body mass index in the range 16-18.5, their percentage was 12.3% of this sample. The percentage of students with overweight was 20%, obese students were 1.54% of this sample. According 7-days ABPM data the mean values ​​of MESORs in overweight female students are higher, but do not have statistically significant differences comparing with normal weight students, vascular variability anomalies (Circadian Hyper_Amplitude_Tension (CHAT), ecphasia) also do not correlate with BMI in young women. However, young men have positive positive correlations between hemodynamic parameters (SBP,  DBP and DP) and body mass index. Key words: overweight, chronostructure, ambulatory blood pressure monitoring, young people

Vascular variability anomalies (VVAs) in children

This work aims at studying in children the prevalence of some vascular variability anomalies (VVAs), i.e. indices of an increased risk of heart and vessel diseases revealed by chronobiologic analysis of cardiovascular monitoring data – systolic (SBP) and diastolic (DBP) MESOR-hypertension/hypotension, circadian hyper-amplitude-tension (CHAT), ecphasia and an excessive pulse pressure (EPP). A reference group of 138 healthy Moscow schoolchildren (age 12–17 years) was used for determination of 90% prediction limits for the circadian parameters of SBP and DBP, specified by gender and age (or height). The test group included another 194 children of the same age range with headache and abnormal BP values by casual measurement. BP data series from each child were analyzed by the COSINOR method. VVAs were found in 44.8% of children from the test group. In boys, VVAs occur more often than in girls (51.5% vs. 30.6%). One child may have up to 3 VVAs. The presence of VVAs may be related to an elevated BMI. The most common VVAs in childhood are the abnormalities of PP and systolic CHAT. Cosinor analysis can reveal a large number of children with PP higher than a threshold (60mmHg) during a relatively long portion of the day (more than 1/3 of the 24h span).

Association of Western Diet and Lifestyle with Circadian Hyperamplitude Tension and Mesor Hypertension Measured by Ambulatory Blood Pressure Monitoring

Effects of Western diet and lifestyle factors resulting in hypertension are known, however, the effects of life- style on blood pressure variability measured by ambulatory blood pressure monitoring are not sufficiently well known. In the present case, it has been observed that Western diet, sedentary behavior and mental load in a subject with normal blood pressures were associated with blood pressure disorders (VVD). Moderation in diet and lifestyle reversed the blood pressure variability, demonstrated by ambulatory blood pressure monitoring.

Abnormalities in circadian blood pressure variability and endothelial function: pragmatic markers for adverse cardiometabolic profiles in asymptomatic obese adults

BackgroundCardiovascular disease (CVD) risk, although perceived to be high, is often difficult to demonstrate in disease free (healthy) obese adults.HypothesisChanges in circadian blood pressure variability (CBPV) and endothelial function (EF) may be early correlates of cardiometabolic disorders.MethodsAsymptomatic men and women in 3 groups: normal weight (n = 10), overweight (n = 10) and obese (n = 15) were evaluated. Blood pressure and heart rate were recorded over 7 days: every 30 minutes during the day and every 60 minutes during the night, by automatic ambulatory monitoring. Resting EF was assessed in a fasting state between 8-10 AM by brachial ultrasound. Anthropometric and cardiometabolic indicators were measured and correlations with CBPV and EF were investigated.ResultsThe 3 groups had (Mean(SD)) BMI: 22.6(1.6), 27(3) and 34(5) kg/m2, respectively, weight: 64(16), 79(14), 95(16) kg and waist circumference: 79(9), 93(10), 107(13) cm. None in normal-weight or overweight groups had abnormal CBPV, while 8 of 15 obese adults had one or more CBPV abnormities (p < 0.05). Obese adults with CBPV abnormalities had elevated hs-CRP (15.3(9.3) mg/L), fibrinogen (593(97) mg/dl), fasting serum glucose (102(16) mg/dL), and cardiac risk ratios (Total-C/HDL-C: 5.2(1.9), LDL-C/HDL-C: 3.1(1.4)). Adults in the 3 respective groups who did not have CBPV abnormalities had flow-mediated brachial artery dilatation (FMD) of 0.22(0.06); 0.20(0.04), 0.23(0.02) mm over resting diameter. Obese participants with CBPV abnormalities (Mesor-hypotension, circadian hyper amplitude tension, elevated pulse pressure), had attenuated FMD at 78, 52, and 56% of resting reference diameter (means 0.18(0.07), 0.12(0.08), and 0.13(0.05) mm; p < 0.05), respectively.ConclusionsAsymptomatic obese adults with abnormal CBPV and EF exhibit unfavorable cardiometabolic profiles.

Prediabetes is associated with abnormal circadian blood pressure variability

Blood pressure (BP) exhibits a circadian variation characterized by a morning increase, followed by a small postprandial valley and a deeper descent during nocturnal rest. Although abnormal 24-h variability (abnormal circadian variability (ACV)) predicts adverse cardiovascular disease (CVD) outcomes, a 7-day automatic ambulatory BP monitoring (ABPM) and subsequent chronobiologic analysis of the gathered data, permits identification of consistency of any abnormal circadian variation. To test whether normal overweight healthy men and women with prediabetes differed from subjects with normoglycemia in having ACV with a 7-day ABPM. Consent for a 7-day ABPM was obtained from subjects with family history of diabetes mellitus, who were participating in the screening phase for a randomized, double blind, placebo-controlled weight loss trial in prediabetics to prevent progression to diabetes mellitus. The automatic 7-day ABPM device recorded BP and heart rate every 30 min during the day and every 60 min during the night. Normoglycemic and prediabetic subjects matched for age, sex, race, BP, BMI, waist circumference and glycemic control, differed statistically significantly only in their fasting and/or 2-h postprandial serum glucose concentrations. Chronobiologically-interpreted 7-day ABPM uncovered no abnormalities in normoglycemics, whereas prediabetics had a statistically significantly higher incidence of high mean BP (MESOR-hypertension), excessive pulse pressure and/or circadian hyper-amplitude-tension (CHAT) (P<0.001). ACV detected with 7-day ABPM may account for the enhanced CVD risk in prediabetes. These findings provide a basis for larger-scale studies to assess the predictive value of 7-day ABPM over the long term.

Chronobiology Predicts Actual and Proxy Outcomes when Dipping Fails

To the Editor: As a gauge of variability, dipping, based on day-night ratios of blood pressure, is much discussed,1 with 2194 hits in a search of the literature on the Internet. But, as compared with dipping, a classification based on chronobiological end points (such as the circadian amplitude and phase) interpreted in the light of reference values specified by gender and age offers superior discrimination in our data. Abnormality in the normal range can occur as (1) a (circadian) blood pressure overswing or circadian hyper-amplitude-tension (CHAT) gauged by a circadian amplitude exceeding the upper prediction limit of presumably clinically healthy peers of the same gender, age group, and ethnicity; (2) an excessive pulse pressure gauged by a persisting excessive difference between systolic pressure, when the heart contracts, and diastolic pressure, when the heart relaxes, measured around-the-clock; (3) circadian ecphasia, an odd timing of the daily blood pressure swing in the absence of an oddly timed daily heart rate pattern to rule out effects of work and sleep schedule shifts that may affect the timing of both blood pressure and heart rate rhythms; or (4) too little heart rate jitter, gauged by a reduced around-the-clock standard deviation of heart rate. In a 6-year prospective study of 297 patients with no initial history of morbid cardiovascular event undergoing 48-hour ambulatory blood pressure monitoring,2 a circadian amplitude above the upper 95% prediction …

Chronobiology's progress. Part II, chronomics for an immediately applicable biomedicine

Chronomic cardiovascular surveillance serves to recognise and treat any risk elevation as well as overt disease, and to ascertain whether treatment is effective and, if so, for how long treatment effects lasts, be it for lowering an increased risk and/or in surveilling the success or failure of treatment. A treatment-associated increase in circadian amplitude of blood pressure (BP) may induce iatrogenic overswinging, also dubbed CHAT ( circadian hyper- amplitude- tension), in some patients, thereby increasing cardiovascular disease risk unknowingly to care provider and receiver.

Chronobiology's progress. Part I, season's appreciations 2004-2005: time-, frequency-, phase-, variable-, individual-, age- and site-specific chronomics

New components of transdisciplinary spectra or known components in new variables in us, matching those around us, are being mapped. Their hardly trivial interactions associated with the good and bad around us - from religiosity to crime and war - are being rendered measurable, for the eventual development of countermeasures to the diseases of societies and nations. Internal cycles not only underlie life itself and underlie our evolving genetics at all levels of organization; they also constitute the essential control and reference information in all transdisciplinary science. In preparing for travel to Mars and other missions in space that may take more than a year, let us do what is immediately practicable. Transyears may have very small amplitudes yet are associated with sudden cardiac death in some terrestrial locations; if they should play a role in these electrical incidents of the heart, among others like myocardial infarction and stroke, they will jeopardize lengthy missions in extraterrestrial space, away from hospitals.The likelihood of stroke or cardiac death can be immediately reduced by chronobiologically assessing blood pressure and heart rate variability and by optimizing the efficacy of timed treatment rather than relying on an unacceptable and often inaccurate spotcheck and treating by convenience rather than pertinence. Needed are: detection of nocturnal abnormality when medication may no longer be effective (or is too effective) neither seen during office visits by day; detection of circadian hyper-amplitude-tension (CHAT) associated with a risk of stroke and kidney disease greater than other risks (including hypertension when all risks are assessed concomitantly); detection of CHAT as high risk among normotensives who may not need anti-hypertensive medication; individualized inferential statistical testing to determine whether a drug or non-drug intervention such as autogenic training (relaxation) is effective and for how long (detecting any initial and later success or failure), some of which conditions otherwise are not found without chronobiology; individualization of treatment timing, since the same dose of the same medication can further lower the subject's blood pressure average and circadian amplitude when the timing of daily administration is optimized, as ascertained by sequential testing and parameter tests.Thus, we save lives by monitoring and assessing, and if need be treating, vascular disease risk through chronobiologically interpreted 24-hour or preferably longer (24-hour/7-day) blood pressure and heart rate variability. Abnormalities in the variability of blood pressure and heart rate, impossible to find during a conventional office visit (the latter aiming at the fiction of a true blood pressure), can raise cardiovascular disease risk in the next six years from 4% to 100%.

P.2.a.013 Chronobiological thyroid axis dysfunction in depression

Longitudinal records of blood pressure (BP) and heart rate (HR) around the clock for days, weeks, months, years, and even decades obtained by manual self-measurements (during waking) and/or automatically by ambulatory monitoring reveal, in addition to well-known large within-day variation, also considerable day-to-day variability in most people, whether normotensive or hypertensive. As a first step, the circadian rhythm is considered along with gender differences and changes as a function of age to derive time-specified reference values (chronodesms), while reference values accumulate to also account for the circaseptan variation. Chronodesms serve for the interpretation of single measurements and of circadian and other rhythm parameters. Refined diagnoses can thus be obtained, namely MESOR-hypertension when the chronome-adjusted mean value (MESOR) of BP is above the upper limit of acceptability, excessive pulse pressure (EPP) when the difference in MESOR between the systolic (S) and diastolic (D) BP is too large, CHAT (circadian hyper-amplitude tension) when the circadian BP amplitude is excessive, DHRV (decreased heart rate variability) when the standard deviation (SD) of HR is below the acceptable range, and/or ecphasia when the overall high values recurring each day occur at an odd time (a condition also contributing to the risk associated with ‘non-dipping’). A non-parametric approach consisting of a computer comparison of the subject's profile with the time-varying limits of acceptability further serves as a guide to optimize the efficacy of any needed treatment by timing its administration (chronotherapy) and selecting a treatment schedule best suited to normalize abnormal patterns in BP and/or HR. The merit of the proposed chronobiological approach to BP screening, diagnosis and therapy (chronotheranostics) is assessed in the light of outcome studies. Elevated risk associated with abnormal patterns of BP and/or HR variability, even when most if not all measurements lie within the range of acceptable values, becomes amenable to treatment as a critical step toward prevention (prehabilitation) to reduce the need for rehabilitation (the latter often after costly surgical intervention).

Opportunity of detecting pre-hypertension: worldwide data on blood pressure overswinging

Overswinging or CHAT (brief for Circadian Hyper-Amplitude-Tension), that is an excessive circadian variation in blood pressure (BP), has been associated with a large increase in cardiovascular disease risk, present even in the absence of an elevated BP itself. This usually asymptomatic condition is usually overlooked by current practice based on spot-checks, because to be diagnosed, measurements need to be taken around-the-clock, preferably for 7 days at the outset. Once diagnosed, however, a usual circadian BP pattern can be restored by means of certain non-pharmacologic or pharmacologic interventions timed appropriately. Thereby, it is possible to reduce the risk of cardiovascular morbidity and mortality, cerebral ischemic events and nephropathy in particular. For the preparation of guidelines regarding the diagnosis of BP disorders and for the institution of primary as well as secondary preventive measures, it is important to know what the incidence of CHAT is on a global basis. We found 191 cases of CHAT among 1602 mostly 7-day/24-h BP profiles, obtained from several centers in different countries participating in an ongoing project on the BIOsphere and the COSmos (BIOCOS). CHAT incidence is about the same between men and women, but it is diagnosed more often among patients with borderline hypertension or with glucose intolerance. It is also more common among MESOR-hypertensive than among MESOR-normotensive individuals. Priority should be given to the development of an unobtrusive and affordable device to automatically monitor BP and to analyze the data as-one-goes, so that cardiovascular disease risk can be prevented.

Circadian and circaseptan (about-weekly) aspects of immigrant Indians' blood pressure and heart rate in California, USA

Time structurally (chronomically) interpreted half-hourly monitoring of blood pressure (BP) and heart rate (HR) for at least 7 days and preferably for 17 days is recommended, separately for a diagnosis of BP disorders and when necessary again for the same or longer spans for treatment, whenever a positive diagnosis of a disorder is made. In this study, 30 clinically healthy subjects underwent 7-day monitoring and provided a series of findings, including the detection of Circadian Hyper-Amplitude-Tension (CHAT), that is blood pressure overswinging, which carries a high risk of hard cardiovascular events. The results specifically bear upon south-east Asian-Indian immigrants. They show that cardiovascular disease risk increases with age, with a positive family history of hypertension and/or other cardiovascular diseases and even with the duration of stay in the USA. A relation to body mass index is also shown. Such monitoring for prehabilitation may eventually reduce the need for rehabilitation.

Why continued surveillance? Intermittent blood pressure and heart rate abnormality under treatment

Several opinion leaders have monitored their blood pressure systematically a sufficient number of times a day for chronomic (time structural) analyses, from the time of encountering chronobiology until their death; they set an example for others who also may not wish to base treatment on single spotchecks in a health care office. Such self-measurements, while extremely helpful, were not readily feasible without a noteworthy interruption of activities during waking as well as of sleep. New, relatively unobtrusive instrumentation now makes monitoring possible and cost-effective and will save lives. Illustrative results and problems encountered in an as-one-goes self-survey by GSK, a physician-scientist, are presented herein. Both MESOR-hypertension and CHAT (circadian hyper-amplitude-tension) can be intermittent conditions even under treatment, and treatment is best adjusted based on monitoring, rather than “flying blind”.

ACE Inhibitors and Chronotherapy

Chronotherapy can improve the effectiveness and reduce the adverse reactions of drugs and actually is used for several conditions including cardiovascular diseases. Although angiotensin converting enzyme (ACE) inhibitors are available for the therapy of patients with hypertension and/or heart failure, these agents have some characteristic adverse effects such as angioedema and dry cough. It has been reported that the dosing of ACE inhibitor at an inactive period has a better protective effect against cardiac hypertrophy in hypertensive rats, and changing dosing time from morning to evening reduces the severity and frequency of the drug-induced dry cough of hypertensive patients treated in the morning. Thus, the dosing of ACE inhibitors in the inactive span is more effective and safe. Dosing in the evening may be an alternative for hypertensives with dry cough with a morning dose of ACE inhibitors, if one ascertains that no circadian hyperamplitude tension is induced by the evening dose of this or any other antihypertensive drug.

100 or 30 years after Janeway or Bartter, Healthwatch helps avoid ‘flying blind’

Longitudinal records of blood pressure (BP) and heart rate (HR) around the clock for days, weeks, months, years, and even decades obtained by manual self-measurements (during waking) and/or automatically by ambulatory monitoring reveal, in addition to well-known large within-day variation, also considerable day-to-day variability in most people, whether normotensive or hypertensive. As a first step, the circadian rhythm is considered along with gender differences and changes as a function of age to derive time-specified reference values (chronodesms), while reference values accumulate to also account for the circaseptan variation. Chronodesms serve for the interpretation of single measurements and of circadian and other rhythm parameters. Refined diagnoses can thus be obtained, namely MESOR-hypertension when the chronome-adjusted mean value (MESOR) of BP is above the upper limit of acceptability, excessive pulse pressure (EPP) when the difference in MESOR between the systolic (S) and diastolic (D) BP is too large, CHAT (circadian hyper-amplitude tension) when the circadian BP amplitude is excessive, DHRV (decreased heart rate variability) when the standard deviation (SD) of HR is below the acceptable range, and/or ecphasia when the overall high values recurring each day occur at an odd time (a condition also contributing to the risk associated with ‘non-dipping’). A non-parametric approach consisting of a computer comparison of the subject's profile with the time-varying limits of acceptability further serves as a guide to optimize the efficacy of any needed treatment by timing its administration (chronotherapy) and selecting a treatment schedule best suited to normalize abnormal patterns in BP and/or HR. The merit of the proposed chronobiological approach to BP screening, diagnosis and therapy (chronotheranostics) is assessed in the light of outcome studies. Elevated risk associated with abnormal patterns of BP and/or HR variability, even when most if not all measurements lie within the range of acceptable values, becomes amenable to treatment as a critical step toward prevention (prehabilitation) to reduce the need for rehabilitation (the latter often after costly surgical intervention).

Transient circadian hyper-amplitude-tension (CHAT) may be intermittent: case reports illustrating gliding spectral windows

Taking the heart rate (HR) for one cycle, whether to examine behavior in the region of periods of 1 s, 1 day, 1 week, 1.3 or 10.5 years, etc., is hazardous. Replications, when possible are mandatory for examining altered variability, whatever the period(s) involved may be. This replication in the individual, and across individuals when the periods are long, measured in decades, may serve for diagnosis and treatment. This rule applies in particular to a seemingly transient circadian hyper-amplitude-tension (CHAT), an over peer-threshold variability in blood pressure (BP), based on the fit of a 24-h cosine curve to time series of appropriate length, rather than to a mere snapshot covering just a single day or week. Transient CHAT may turn into intermittent CHAT, as determined in two cases presented herein. One case of transient CHAT could be so named after a successful treatment (R x) change eliminated CHAT as an effect validated by monitoring at 30-min intervals for a 7-day span on a new treatment. CHAT disappeared for over 300 consecutive half-hourly measurements, but thereafter it reappeared. During the ensuing nearly continuously monitored 5 years, CHAT continued to appear and disappear sometimes without a treatment change. In another case, which was responsive to a change in the timing of medication, CHAT also disappeared and thereafter reappeared. In a short-term perspective of weeks or months of monitoring, CHAT seemed to be transient, but further monitoring again revealed it to be intermittent. Cases of intermittent CHAT require follow-up for outcomes by comparison with the population at large. Miniaturized instrumentation for their detection should be a high priority, but it must be realized that the automatic ambulatorily functioning monitors, available at 10% of the regular price through a BIOCOS project (corne001@umn.edu), already signify great progress, as compared to previously used manual measurements made around the clock by hypertensive opinion leaders in medicine from diagnosis to death. On automatically collected time series of BP and HR, gliding pergressive spectral windows as such, or such pergressive windows aligned further with global spectral windows, visualize the changing dynamics involved in health and disease, in the steps of Werner Menzel and Paolo Scarpelli.

Effects of Autogenic Training and Antihypertensive Agents on Circadian and Circaseptan Variation of Blood Pressure

Even when the daily blood pressure mean is acceptable, too large a circadian amplitude of blood pressure largely increases cardiovascular disease risk. Autogenic training (N = 11), a non‐pharmacologic intervention capable of lowering an excessive blood pressure variability, may be well‐suited for MESOR‐normotensive patients diagnosed with circadian‐hyper‐amplitude‐tension (CHAT). Not all anti‐hypertensive drugs affect blood pressure variability. Accordingly, long‐acting carteolol (N = 11) and/or atenolol (N = 8) may be preferred to captopril retard (N = 13), nilvadipine (N = 8), or amlodipine (N = 7) for midline‐estimating statistic of rhythm (MESOR)‐hypertensive patients with CHAT. Prospective outcome studies are needed to assess whether the relative merits of these treatments are in keeping with their effects on blood pressure and blood pressure variability.

Circadian heart rate and blood pressure variability considered for research and patient care

Objectives: To review mechanisms of circadian variations in heart rate variability (HRV) and blood pressure variability (BPV) and mortality and morbidity due to cardiovascular diseases (CVD). Methods: Results from 7-day/24-h HRV and BPV are interpreted by gender and age-specified reference values in the context of a Medline search. Results: Abnormal HRV and BPV measured around the clock for 7 days provides information on the risk of subsequent morbid events in subjects without obvious heart disease and without abnormality outside the conventional (in the sense of chronobiologically unquantified) physiological range. Meditation, β-blockers, ACE inhibitors, n-3 fatty acids and estrogens may have a beneficial influence on HRV, but there is no definitive outcome-validated therapy. Low HRV has been associated with a risk of arrhythmias and arrhythmic death, unstable angina, myocardial infarction, progression of heart failure and atherosclerosis. BPV may be characterized by treatable circadian-hyper-amplitude-tension (CHAT), which can be transient ‘24-h CHAT’ or ‘7-day-CHAT’, MESOR-hypertension and/or an unusually-timed (odd) circadian acrophase (ecphasia), all associated with an increased risk of stroke, stroke death, myocardial infarction, and kidney disease. Conclusions: Precise insight into the patho-physiology in time of HRV and BPV is needed with development of a consensus on best measures of HRV for clinical purposes and to determine when a 7-day record interpreted chronobiologically suffices and when it does not, for detection within as well as outside the conventional normal range, for diagnostic clinical practice and to direct therapy of risk greater than that associated with hypertension, smoking or any other risk factor.