Jiří Dušek

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.

3D.06: BLOOD PRESSURE VARIABILITY AT REST AND DURING EXERCISE IN HEALTHY MEN: SEVEN DAY AMBULATORY BLOOD PRESSURE MONITORING.

Objective: The aim of the study was to compare 24-hour profile from the 7-day blood pressure monitoring at rest and during exercise. From the seven day ambulatory blood pressure monitoring we compared the blood pressure 24 h profile in the day with exercise (0–24 h) and in the day without exercise (25–48 h after exercise). Design and method: We examined 21 men, healthy subjects, age 29 ± 4.9 years. For exercise training we used bicycle ergometer Kettler, type X7, Germany. The subjects were recruited for seven-day blood pressure monitoring (A and D, Japan). To made comparison among the 24-h profile of blood pressure in the days with exercises (0–24 h) and the days without exercise (25–48 h) we used Bland-Altman statistical method. Results: The 24-hour mean SBP in the day with exercise (119 ± 2.1 mmHg) and in the day without exercise (119 ± 1.7 mmHg) and the 24-hour mean DBP in the day with exercise (69 ± 1.5 mmHg) and in the day without exercise (69 ± 1.5 mmHg) in 21 healthy subject was not different. Comparisons between 7-days mean and 24-hour means SBP in the days with exercise using Bland-Altman plot showed the limits of agreement in the day with exercise (the ± 1.96 SD of the difference in 24-hour means of SBP was 6.85 mmHg and in the days without exercise the limits of the agreement (the ± 1.96 SD of the difference) was 8.59 mmHg. Bland-Altman plot comparisons between 7-days mean and 24-hour means DBP in the days with exercise the limits of the agreement (the ± 1.96 SD of the difference in DBP) was 4.95 mmHg and in the days without exercise (the ± 1.96 SD of the difference in DBP) was 6.06 mmHg. Conclusions: Our results showed large variability of mean 24 h SBP in the days with exercise and also in the days without exercise and also in DBP the variability is similarly large. Bland –Altman plots comparing daily SBP and DBP in days with exercise and without exercise showed that the 24 h means of blood pressure were not affected by exercise, and also the blood pressure variability was not affected.

Seven-day ambulatory blood pressure monitoring and day andnight blood pressure variability

The paper deals with seven-day ambulatory blood pressure monitoring and day and night blood pressure variability.

TWENTY FOUR-HOUR PROFILE OF BLOOD PRESSURE AFTER 60-MINUTES LASTING CARDIAC EXERCISE TRAINING IN PATIENTS AFTER MYOCARDIAL INFARCTION: PP.14.22

Objective: The aim of the study was to compare 24-hour course of blood pressure immediately after the exercise training with the values from the following day when the patients after myocardial infarction did not exercise. Method: The group being monitored consisted of 23 patients after myocardial infarction of the age 63 ± 6.3 years and ejection fraction 43 ± 12.3 %. In the course of cardiac rehabilitation (aerobic and resistance training, lasted 60 minutes), the patients were subjected to 7-day ambulatory blood pressure monitoring (AD TM2421 Japan). During 7-day blood pressure monitoring their pharmacotherapy was not interrupted and consisted of ACE inhibitors, betablockers and statins. Results: The mean values of 24-h blood pressure profile (systolic ad diastolic) did not differ between the day with exercises and the day without exercise (120 ± 9 versus 120 ± 8mmHg, 72 ± 8 versus 72 ± 8mmHg). Comparison of hour differences in systolic and diastolic blood pressure indicated that only in the first hour after the exercises training the systolic pressure is lower than in the check course (120 + 4 mmHg versus 125 + 3 mmHg, p < 0.01). Also in the second hour after the exercises the value is lower, the difference, however, is not statistically significant any more. In the other hours both profiles were not different. We have found no differences in diastolic pressure. Conclusion: The analysis of 24-hour profile of systolic and diastolic blood pressure showed that the exercise training change systolic blood pressure only one hour immediately after the exercises.

ESTIMATION OF THE BAROREFLEX GAIN IN MAN USING THE MODEL OF THESYMPATHETIC SYSTEM TRANSFER FUNCTION.

ESTIMATION OF THE BAROREFLEX GAIN IN MAN USING THE MODEL OF THE SYMPATHETIC SYSTEM TRANSFER FUNCTION.