1 Need for 7-day/24-hour ABPM interpreted chronobiologically: consensus 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 pressure monitoring study we described the relationship between age and MESOR of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in heathy subjects (n=84)

 MESOR - mean values of systolic SBP and DBP were increasing with age up to 75 years.

Comparison between casual blood pressure measurements and 7-day blood pressure monitoring

Our results clearly indicate the advantage of the long term blood pressure monitoring over casual blood pressure measurement for the blood pressure evaluation.

 Evaluation of blood pressure amplitude of circadian cycle by 7-day ambulatory blood pressure ambulatory monitoring

 Double amplitude of SBP and DBP reached the maximum value at 45 years and then decreased (Hypertension 2006).

 Forty patients after myocardial infarction (IM) treated with beta-blockers, Ca-antagonists and ACE-inhibitors (age between 41 and 77 years, mean age 61 years) were compared with 44 healthy controls (C, age between 40 and 77 years, mean age 54 years). TREATED PATIENTS WITH ISCHEMIC HEART DISEASE

 A significant increase of SBP MESOR with age was found in C (r=0.39, p<0.01), but not in IM (r=0.23).  Mean value of SBP MESOR was higher in C than in IM (128±9 vs. 121±8 mmHg, p<0.01), as well as DBP MESOR (81±7 vs. 74±7 mmHg, p<0.01).  Decrease of DBP with age in IM was observed (r=0.362, p<0.05).

 Double amplitude SBP decreased with age in C (r=0.30, p<0.05) but not in IM (r=0.03).  Similarly double amplitude DBP decreased with age in C (r=0.41, p<0.01) and not in IM (r=0.08).  Mean values of double amplitude were lower in IM (DA SBP: 21±10 vs. 16±8 mmHg, p<0.01; double amplitude DBP: 16±8 vs. 12±5 mmHg, p<0.01). Heart rate (HR) was not age related in both groups, difference in mean values of HR was not observed (C: 71±10, IM: 65±8 bpm).  Double amplitude HR was lower in IM (15±8 vs. 9±5 bpm).

 This decline of double amplitude was not seen in our patients with heart disease. Furthermore double amplitude in about 50 years old treated patients was lower than in our about 50 years of age controls. This fact is positive because excessive circadian double amplitude (CHAT) is accompanied with an increased risk for morbidity and mortality.

BRNO CONSENSUS

Extended consensus on need and means to detect vascular variability disorders (VVDs) and vascular variability syndromes (VVSs) F. Halberg, G. Cornélissen, K. Otsuka, J. Siegelova, B. Fiser, J. Dusek, P. Homolka, S.Sanches de la Pena, R.B. Singh and the BIOCOS project

Given that conventional health care practice is concerned mainly with high blood pressure (BP), and given the fact that other variability disorders – circadian overswing, excesive pulse pressure, odd circadian BP timing and deficient heart rate (HR) variability (in their own right or in combination with MESOR – hypertension) – are not diagnosed but contribute to cardiovascular disease risk, we wanted to find out 1. how many patients escape current diagnosis (and treatment), and 2. what are the risks such patients incur.

Thank you for the attention. Support: MSM