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Since 1999 ISSN 2226-7425
The journal of scientific articles “Health & education millennium” (series Medicine), 2012, tom 14 [1]
Shastun S., Chibisov S., Agarval R., Singh R.B., Wilson D.W., De Meester F, Halberg F., Cornelissen G.
People,s Friendship University of Russia,Halberg Hospital and Research Institute, Moradabad, India; Durham University, Durham, UK, Tsim Tsoum Institute, Krakow,Poland; University of Minn Medical School, Minneapolis, USA.
BLOOD PRESSURE VARIABILITY AND STABILITY:THE FUTURE OF CARDIOVASCULAR PROTECTION.
Background. There is a widespread belief that underlying usual blood pressure can alone account for all Blood pressure (BP) related risk of vascular events and for the benefits of antihypertensive drugs. Other potential BP markers such as variability in clinic BPs, maximum rise in BPs, and over-swinging that is an excessive circadian variation in BPs, have been associated with a large increase in cardiovascular disease (CVD) risk, present even in the absence of an elevated BP. These asymptomatic markers are usually neglected by current practice based on spot checks, because to be diagnosed, measurement need to be taken around the clock, preferably for 7 days at the outset. The effects of antihypertensive drugs on these markers in a large randomized, controlled trial are largely unknown. Clinical guidelines by various agencies do not recommend treatment of these markers and the risk of these markers is ignored. This review discusses on the limitations of random BP levels, provides background to reports on BP variability; MESOR hypertension and Circadian Hyperamplitude Tension (CHAT) in prediction of risk of vascular events and target organ damage.
Methods. Internet search of PubMed, Google, and discussion with BIOCOS group.
Results. We found 194 cases of CHAT among 1714 mostly 7-day /24 hour BP profiles, obtained from seven centers from different countries, at Halberg
Chronobiology Center, Univ of Minn in Minneapolis and Halberg Hospital and Research Institute, Mora-dabad, India. These centers are participating in the ongoing project on the BIOsphere and the Cosmos (BIOCOS). CHAT may be present in absence of increased BPs, in pre-hypertension and in subjects with glucose intolerance. It is also more common among MESOR hypertension subjects compared to subjects having normotension. In a subsample of 112 adults above 25 years of age, serum levels of magnesium and potassium were inversely associated with CHAT and MESOR hypertension. There is little evidence that CoQ10, w-3 fatty acids and ACE-inhibiters may be protective against CHAT.
Conclusions. Apart from levels of BPs, its variability, instability and extent of circadian changes appear to be important. It is possible that priority should be given to the development of an unobtrusive and affordable device to monitor BPs for 7days to diagnose vascular variability disorders and to analyse data as -one-goes, for prevention of vascular events. Case control studies and randomized controlled trial with various agents are necessary to confirm their role in the prevention of BP variability.
Correspondence.
Prof. Dr RB Singh, MD,FICN Halberg Hospital and Research Institute, Civil Lines, Moradabad-10 (UP)244001,India
