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Need for 7-day/24-hour ABPM Need for 7-day/24-hour ABPM interpretedinterpreted chronobiologically: chronobiologically:
consensusconsensus
Dedicated to Prof. Franz Halberg, Dr. M.D., Dr. h.c. multi
Jarmila Siegelova, Jiri Dusek, Pavel Homolka, Jarmila Siegelova, Jiri Dusek, Pavel Homolka, Dept. of Physiotherapy and Rehabilitation and
Department of Functional Diagnostics and Rehabilitation, Masaryk University Brno, St. Anna
Faculty Hospital Brno, Czech Republic
In our recent 7-day ambulatory blood In our recent 7-day ambulatory blood pressure monitoring study we described the pressure monitoring study we described the
relationship between age and relationship between age and MESORMESOR of of systolic blood pressure (SBP) and diastolic systolic blood pressure (SBP) and diastolic blood pressure (DBP)blood pressure (DBP) in heathy subjects in heathy subjects
(n=84)(n=84)
Relationship between mean SBP and age
y = 0,0097x2 - 0,5478x + 129,57
R2 = 0,2151
0,000
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
0 10 20 30 40 50 60 70 80
year
mm
Hg
Relationship between mean DBP and age
y = -0,0074x2 + 0,9514x + 52,901
R2 = 0,3844
0
20
40
60
80
100
120
0 10 20 30 40 50 60 70 80
year
mm
Hg
MESOR - mMESOR - mean values of systolic ean values of systolic SBP and DBP were increasing with SBP and DBP were increasing with age up to 75 yearsage up to 75 years..
CComparison between casual omparison between casual blood pressure blood pressure
mmeasurements and 7-day easurements and 7-day blood pressure monitoringblood pressure monitoring
SBP
y = 1,0305x - 1,219R2 = 0,3687
0
20
40
60
80
100
120
140
160
180
200
80 90 100 110 120 130 140 150 160
MESOR (mmHg)
ON
E B
LOO
D P
RE
SS
UR
E
ME
AS
UR
EM
EN
T (m
mH
g)
DBP
y = 1,0838x - 2,9439
R2 = 0,4838
0
20
40
60
80
100
120
0 20 40 60 80 100 120
MESOR (mmHg)
ON
E M
EA
SU
RE
MN
T (m
mH
g)
Our results clearly indicate the Our results clearly indicate the advantage of the long term advantage of the long term blood pressure monitoring over blood pressure monitoring over casual blood pressure casual blood pressure measurement for the blood measurement for the blood pressure evaluation. pressure evaluation.
Evaluation of blood pressure Evaluation of blood pressure amplitude of amplitude of circadian cyclecircadian cycle by 7-day ambulatory blood by 7-day ambulatory blood pressurepressure ambulatory ambulatory monitoringmonitoring
Circadian amplitude SBP and age
y = -0,0059x2 + 0,5526x - 0,6632
R2 = 0,108
0,0
5,0
10,0
15,0
20,0
25,0
15 25 35 45 55 65 75
year
mm
Hg
Circadian amplitude DBP and age
y = -0,0068x2 + 0,5899x - 3,3926
R2 = 0,1671
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
16,0
18,0
20,0
15 25 35 45 55 65 75
year
mm
Hg
Circadian amplitude HR and age
y = -0,0008x2 + 0,0309x + 8,3112
R2 = 0,0304
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
16,0
18,0
15 25 35 45 55 65 75
year
bpm
DDouble amplitudeouble amplitude of SBP and DBP reached of SBP and DBP reached the maximum value at 45 years and then the maximum value at 45 years and then decreased (Hypertension 2006). decreased (Hypertension 2006).
Forty patientsForty patients after myocardial infarction (IM) after myocardial infarction (IM) treated with beta-blockers, Ca-antagonists treated with beta-blockers, Ca-antagonists and ACE-inhibitors (age between 41 and 77 and ACE-inhibitors (age between 41 and 77 years, mean age 61 years) were compared years, mean age 61 years) were compared with with 44 healthy controls44 healthy controls (C, age between 40 (C, age between 40 and 77 years, mean age 54 years). and 77 years, mean age 54 years).
TREATED PATIENTS WITH TREATED PATIENTS WITH ISCHEMIC HEART DISEASEISCHEMIC HEART DISEASE
SBP
y = 0,4117x + 105,93R2 = 0,1521
y = 0,249x + 105,47R2 = 0,0555
0
20
40
60
80
100
120
140
160
180
0 10 20 30 40 50 60 70 80 90
AGE (year)
ME
SO
R (
mm
Hg
)
controls
IM
DBP
y = -0,1103x + 87,763R2 = 0,0208
y = -0,3582x + 96,322R2 = 0,1315
0
20
40
60
80
100
120
0 10 20 30 40 50 60 70 80 90
AGE (year)
ME
SO
R (
mm
Hg
)
controls
IM
HR
y = -0,0205x + 71,653R2 = 0,0004
y = -0,1705x + 80,733R2 = 0,0273
0
20
40
60
80
100
120
0 10 20 30 40 50 60 70 80 90
AGE (year)
ME
SO
R (
cpm
)
controls
IM
A significant increase of SBP MESOR with A significant increase of SBP MESOR with age was found in C (r=0.39, p<0.01), but not age was found in C (r=0.39, p<0.01), but not in IM (r=0.23). in IM (r=0.23).
Mean value of SBP MESOR was higher in C Mean value of SBP MESOR was higher in C than in IM (128±9 vs. 121±8 mmHg, than in IM (128±9 vs. 121±8 mmHg, p<0.01), as well as DBP MESOR (81±7 vs. p<0.01), as well as DBP MESOR (81±7 vs. 74±7 mmHg, p<0.01). 74±7 mmHg, p<0.01).
DDecrease of DBP with age in IM was ecrease of DBP with age in IM was observed (r=0.362, p<0.05). observed (r=0.362, p<0.05).
SBP
y = -0,3359x + 39,622R2 = 0,0922
y = -0,0317x + 17,834R2 = 0,0011
0
5
10
15
20
25
30
35
40
45
50
0 10 20 30 40 50 60 70 80 90
AGE (year)
DO
UB
LE
AM
PL
ITU
DE
(m
mH
g)
controls
IM
DBP
y = -0,3763x + 36,71R2 = 0,1714
y = -0,0465x + 14,795R2 = 0,0063
0
5
10
15
20
25
30
35
40
45
0 10 20 30 40 50 60 70 80 90
AGE (year)
DO
UB
LE
AM
PL
ITU
DE
(m
mH
g)
controls
IM
HR
y = -0,0277x + 16,131R2 = 0,0009
y = -0,0411x + 11,082R2 = 0,0046
0
5
10
15
20
25
30
35
0 10 20 30 40 50 60 70 80 90
AGE (year)
DO
UB
LE
AM
PL
ITU
DE
(cp
m)
controls
IM
Double amplitudDouble amplitudee SBP decreased with age in C SBP decreased with age in C (r=0.30, p<0.05) but not in IM (r=0.03). (r=0.30, p<0.05) but not in IM (r=0.03).
Similarly Similarly double amplitudedouble amplitude DBP decreased with DBP decreased with age in C (r=0.41, p<0.01) and not in IM (r=0.08). age in C (r=0.41, p<0.01) and not in IM (r=0.08).
Mean values of Mean values of double amplitudedouble amplitude were lower in IM were lower in IM (DA SBP: 21±10 vs. 16±8 mmHg, p<0.01; (DA SBP: 21±10 vs. 16±8 mmHg, p<0.01; double double amplitudeamplitude DBP: 16±8 vs. 12±5 mmHg, p<0.01). DBP: 16±8 vs. 12±5 mmHg, p<0.01). Heart rate (HR) was not age related in both Heart rate (HR) was not age related in both groups, difference in mean values of HR was not groups, difference in mean values of HR was not observed (C: 71±10, IM: 65±8 bpm). observed (C: 71±10, IM: 65±8 bpm).
Double amplitude Double amplitude HR was lower in IM (15±8 vs. HR was lower in IM (15±8 vs. 9±5 bpm).9±5 bpm).
This decline of This decline of double amplitudedouble amplitude was not was not seen in our patients with heart disease. seen in our patients with heart disease. Furthermore Furthermore double amplitudedouble amplitude in about 50 in about 50 years old treated patients was lower than in years old treated patients was lower than in our about 50 years of age controls. This fact our about 50 years of age controls. This fact is positive because excessive is positive because excessive circadian circadian double amplitudedouble amplitude (CHAT) (CHAT) is accompanied is accompanied with an increased risk for morbidity and with an increased risk for morbidity and mortality. mortality.
Extended consensus on need and Extended consensus on need and means to detect vascular variability means to detect vascular variability
disorders (VVDs) and vascular disorders (VVDs) and vascular variability syndromes (VVSs)variability syndromes (VVSs)
F. Halberg, G. Cornélissen, K. Otsuka, F. Halberg, G. Cornélissen, K. Otsuka, J. Siegelova, B. Fiser, J. Dusek, P. J. Siegelova, B. Fiser, J. Dusek, P.
Homolka, S.Sanches de la Pena, R.B. Homolka, S.Sanches de la Pena, R.B. Singh and the BIOCOS project Singh and the BIOCOS project
Given that conventional health care practice isGiven that conventional health care practice is concerconcernedned mainly with high blood pressure mainly with high blood pressure (BP), and given the fact that o(BP), and given the fact that otther variability her variability disorders – circadian overswing, excesive disorders – circadian overswing, excesive
pulse pressure, odd circadian BP pulse pressure, odd circadian BP ttiming and iming and ddeeficient heart rate (HR) variability (in their ficient heart rate (HR) variability (in their own right or in combination with MESOR – own right or in combination with MESOR –
hypertension) – are not diagnosed but hypertension) – are not diagnosed but contribute to cardiovascular disease risk, we contribute to cardiovascular disease risk, we
wanted to find out 1. how many patients wanted to find out 1. how many patients eesscape current diagnosis (cape current diagnosis (aand treatment), and nd treatment), and
2. what are the risks such patients incur.2. what are the risks such patients incur.