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.

11

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.

BRNO CONSENSUSBRNO CONSENSUS

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.

Thank you for the attention.Thank you for the attention.

Support: MSM0021622402Support: MSM0021622402