- Email: [email protected]
G58 Demonstration “The old way” of the need for modern long-term cardiovascular monitoring
7
ASH XII ABSTRACTS
G57 morn 7-DAY AND cfRcADIm CHANCESINCOLD PRESSORTmT G (CPT)RESULTSAND IN VASCULAR DISEASE. MS Lee, ~, Com4)issen, F Halberg, Depts. of Medicine LQLab. Medicine & Pathology,Univ. of Minnesota,Minnca@is, MN, USA We assess abut-daily (circadiaa)and about-weekly(circaseptan, CS) changesin the blocd pressure(BP) responaeto the l-rein immersion of the handinto ice water(CPT).(Anabnut-8mm Hg BP increase in the CPT is repnrtcdfor hcakth;an elevation[>25mm Hg] in patients with “hypertension”is viewedas prcdiasase.Variablesrclamdto the vascular system exhibit prominent CS, circannttak and circadisns, amongothercompnnentaof dreirgeneticallyanchoredtime structureor cbronome.)A 16-year-oldwoman (ML) immersctfher hand into ice watmevery24 hoursfor 2 daysandoncedailyin the morningtberesftcr for 1 week (N=25),as did, only for I day, 4 adults 20-66ycaraof age. BP and beertrate (HR) were monitoredautomaticallyat l-rein intervals beforeand immediatelyafter CPT. Data were analyzedby tbe cosinormethod.l%edifferencebetweenthefiratpost-CPTBPvalueand the meanof the last 7 values prior to the CPT was a measureof CPT respnnse(at l-rein). Overall,ML’s systnlic(S) BP increaaedby 8.2 t 1.4 mm Hg and her diastolic(D) BP by 6.2 * 0.9 mm Hg (PcO.CO1). Increaseswere foundin 96% of the tests for SBP, 92% for DBP and 20% for HR. (Therewas only 1 tie for Hff [4%],rcstdtingin a HR dccreaaein 76% of CPTS.)The BP responseto CPT at 1 min after CPT was CS-dependent.The CS doubleamplitudesarc 12.5+ 4.1 (P=0,019) for SBP and 7.8 * 2.8 mm Hg (P=O.030)for DBP, with acrnpheaes nccttrringon late Sunday,cady Monday (at -50” and -67” from CO:COon Sunday for SBP and DBP, respectively, with 3600=1 week). The rcsponaeof HR did notatlowthedetectionofa rbytbm (P=O.%9). The circadianrc.spnnsc peakedin theearly morninghours(SBP:-80°;DBP; -1130),in keeping with results from the 4 adult subjaaa (SBP: -37°; DBP: -420),individualdifferencesnotwithstanding.The averagetiming of the krrgestoverall responseof BP m CPT coincideswith the timing nf the responseto other stimuli.The CS acrnphascscoincidewith tbe times of increased morbiditylmortality from vascular diseases demonstrated on over 100,000 cases (Corn41issen G. et al. Chronobiologia20: 87-115,1993).Chronomes,time smucmresbrnader than circadian, notably their about-weeklycomponents, should be consideredin intcrpfctingBP resprmsesas a gaugeof vasculardisease status in adolescents,not only at the extremesof life wbcn the CS and about-half-weeklyrhythmsare particularlyprominentin BP andHR.
Key Words: cold presser test, about-weekly (circaseptan) rhythm, blood pressure, vascular disease risk, morbidity, mortality
10, NO. 4, PART 2
G58 DEMONSTRATION’THE OLDWAY” DFTHBNEEtJkQRMODERN f.ONG TERM CARDIOVASCULARMONkTOfUNO. ~ ,KTokbeva, G Com41isscn,K Akhmetov,M Teihlnom,F H~’rg, Hospitat#60, Moscow,Russia Morbidityend mortalitypatterns show the importance,with the circadian (CD), of abmtt-wcckty(circaseptan,CS) and about-hstfwcskfy(cbcaacmiseptan,CSS) hemodynanricrhyrJrmsberemappedin stageII hypwtensivepatients,beforestartingRx. Aimingfor 5 aatnpka par day during 7 consecutivedays (Monday m Sun&y) 36 patients provideddare from at kast 25 of 35 timepnims.Table 1 summarizes single and ppulation-mesn cosinors.The merits of further mapping CS aad CSS in additionto CD emergefrom the P-vatuesfrnm zernamplitude tests; double amplitudes (2A, measures of extent of pmzfictsblechangewitbinacycle);acmpbaacs (4, meaarm?ainnegative degtees of timingof overallhigh valuesrecurringin Wh cyck, with 3fjo0@@ OO=CO:C41 on Sun&y;andM, the (rhythm-adjusted) mean. Table 1:Abnut-wcekfy(CS),batf-weekly(CSS)anddaily(CD)cbmacteristicsofhemndytmmicvariablesin untreatedhypnension (stageff)= Cs Css CD M P 2A $ P 2A P 2A SBP 190.6 0.010 7.14 -3520.021 4,72 -2!5 <.00) 19.01 -? DBP 114.3 0.065 4.73 -3490.119 3,78 -313 <,001 7.19 .17 MAP 138.2 0.011 4,29 -20.063 2.30-239 <.001 10.64 -9 HR 66.60 0.301 1.09 -1670.025 1.71 -47 <.001 2,56-251 S1 36.09 0.1920.53 -2880.133 .676 -S9 0.132 .614 -263 MHV 4.159 0.721 .062 -212 0.036 ,152 .58 <031 .234 -255 CI 2.378 0.850 .026 -2200046 ,092 -57 <.001 .142 -257 TPR 2784, 0.149 105, -23 0.016 143, -241 <.001 299. 44 SPR 507.9 0.04724.0 -11 0,017 23.6-239 <.001 55.1 -39 w 1.157 0005 .040 -344 0,621 .010 -176 <.001 ,088-356 *S=systolic BP=blood pressure (mm Hg); DBP=diastolic BP; MAP=meanartcriaf BP; HR=heartrate (beata/min);Sl=strrrkeindex (ml/m2); MHV=minute heart volume (Ilmin); C1=csrdiac index (1/min/m2);TPR=tetal peripheral resistance (din.cm-s.see); SPR= specificperipheralresistance (din.cm-5.scc/m2);W=ttaeftdworkof the hear f.kgm),For patientsat high vaaculardiseaserisk in particular,the results show the need for automatic took to assess the broader hemodynamic time structures, notably of BP (for which now implamahledeviceshavebeenfunctioningbeat-to-beatforovera year, on the rightbut notyet on the left side of the circulation). abuut-hatf-weekly(circasemisepkm)rhythms,aboutKey Worda: weekly (circaseptan) rhythms, blood pressure, hemodynatnics
G60
G59 NONDIPPERHYPERTENSIVEPATfENTSANDAMBULATORY BLOODPRESSUREREPRODUCIBILITY fVR MI.&Q C. VergasaoJa,G. Garbero,G. Loffi.Hypertension Un~, Dept. of InternalMediune, San MartirrnHospital, Universityof Genoa Madical School, Genoa, Ifsly Purpose ofthastudy was to avaluafe the reproducibilityof ambulatory blood pressure monitoring(ABPM)in hypertensive patients under traafment. The rapmducibiiityof a normal or pathological circadian rhythm(i.a. ths prasencs of a nocturnal fall nf blcod pressure above or balow 10% vs daytima valuas) was assessed as well. 540 palients w“thessential hypertension undarwent ABPMtwice (internal 8-12 weeks). Patients were divided (depending on thair fall of nighttime BP) in: dippsrs (fall > 10% ofdayfima values, N=1B4),nondippers (fall. 10”A, N=12S)and intermediate (systolic alone or diastolic alona fall > 10%, N=228). Afterthe seccmd ABPM93 dippers wara confirmed,31 turned nondippare and BOturned intermediate; 36 nondippers were confirmed, 25 turned dippers and 87 turned intermediate; 11S intennediata wera mnfirmad, 52 turned dippers and = turnad nondippsrs Relationshipa among first and secnnd data eats were highlysignificant (r==.513 to r=0,&7, P
4 AJH-APRIL 1997-vOL.
ABPM,dipper, nondipper, rapmducibilify
EFFECTS OF AMLODIPfNEAND NIFEDfPfNE RETARD ON 24-HOUR BLOOD PRESSURE, HEART RATE AND AUTONOMIC NERVE ACTIVITIES IN HYPERTENSIVE PATIENTS. J Minami, Y Kawsno*, T Ishimitsu, and S Takishita. Division of Hypertension, National Cardiovascular Center, Suitn, Osaka, Japan, We evaluated the effects of l,4-dihydropyridine calcium antagonists with a different biological half-life, amlodipine and nifedipine retard, on 24-hour blood pressure (BP), heart rate (HR) and autonomic nerve activities inpatients with essential hypertension. Twenty hypertensive out-patients (14 women and 6 men; 63*2 yesrs, m+ SE) were enrolled in this study. Ambulatory BPand electrocardiogram were measured for24hourat intervakof 30 minutes using TM-2425 at control period, after 4 weeks of amlodipine administration (Aml: 2.5 mg or 5 mg once daily), and after 4 weeks of nifedipine retard administration (Nif: 10 mg or 20 mg twice daily). The order of the three periods were randomized. Autonomic nerve activities were evafuated by power spectral analysis of HR variability, using the high frequency (HF) component as an index of parasympathetic nerve activity and the ratio of the low frequency (LF) component to HF component (LF/HF) as an index of sympatho-vagal balance. Twenty-four-hour BP waa significantly decreased comparably by AmI or Nif (Aml: - 12.7k2,6/-5.6~l.4 mmHg, P< O.01/P< O.01; Nif: -15. 1*2.1/ -6.9?c1.5 mmHg, P< O,O1/P< O.01). HR did not change by Am], while it was significantly increased by Nif (+3.3* 1.2 bpm, P
ASH XII ABSTRACTS
G57 morn 7-DAY AND cfRcADIm CHANCESINCOLD PRESSORTmT G (CPT)RESULTSAND IN VASCULAR DISEASE. MS Lee, ~, Com4)issen, F Halberg, Depts. of Medicine LQLab. Medicine & Pathology,Univ. of Minnesota,Minnca@is, MN, USA We assess abut-daily (circadiaa)and about-weekly(circaseptan, CS) changesin the blocd pressure(BP) responaeto the l-rein immersion of the handinto ice water(CPT).(Anabnut-8mm Hg BP increase in the CPT is repnrtcdfor hcakth;an elevation[>25mm Hg] in patients with “hypertension”is viewedas prcdiasase.Variablesrclamdto the vascular system exhibit prominent CS, circannttak and circadisns, amongothercompnnentaof dreirgeneticallyanchoredtime structureor cbronome.)A 16-year-oldwoman (ML) immersctfher hand into ice watmevery24 hoursfor 2 daysandoncedailyin the morningtberesftcr for 1 week (N=25),as did, only for I day, 4 adults 20-66ycaraof age. BP and beertrate (HR) were monitoredautomaticallyat l-rein intervals beforeand immediatelyafter CPT. Data were analyzedby tbe cosinormethod.l%edifferencebetweenthefiratpost-CPTBPvalueand the meanof the last 7 values prior to the CPT was a measureof CPT respnnse(at l-rein). Overall,ML’s systnlic(S) BP increaaedby 8.2 t 1.4 mm Hg and her diastolic(D) BP by 6.2 * 0.9 mm Hg (PcO.CO1). Increaseswere foundin 96% of the tests for SBP, 92% for DBP and 20% for HR. (Therewas only 1 tie for Hff [4%],rcstdtingin a HR dccreaaein 76% of CPTS.)The BP responseto CPT at 1 min after CPT was CS-dependent.The CS doubleamplitudesarc 12.5+ 4.1 (P=0,019) for SBP and 7.8 * 2.8 mm Hg (P=O.030)for DBP, with acrnpheaes nccttrringon late Sunday,cady Monday (at -50” and -67” from CO:COon Sunday for SBP and DBP, respectively, with 3600=1 week). The rcsponaeof HR did notatlowthedetectionofa rbytbm (P=O.%9). The circadianrc.spnnsc peakedin theearly morninghours(SBP:-80°;DBP; -1130),in keeping with results from the 4 adult subjaaa (SBP: -37°; DBP: -420),individualdifferencesnotwithstanding.The averagetiming of the krrgestoverall responseof BP m CPT coincideswith the timing nf the responseto other stimuli.The CS acrnphascscoincidewith tbe times of increased morbiditylmortality from vascular diseases demonstrated on over 100,000 cases (Corn41issen G. et al. Chronobiologia20: 87-115,1993).Chronomes,time smucmresbrnader than circadian, notably their about-weeklycomponents, should be consideredin intcrpfctingBP resprmsesas a gaugeof vasculardisease status in adolescents,not only at the extremesof life wbcn the CS and about-half-weeklyrhythmsare particularlyprominentin BP andHR.
Key Words: cold presser test, about-weekly (circaseptan) rhythm, blood pressure, vascular disease risk, morbidity, mortality
10, NO. 4, PART 2
G58 DEMONSTRATION’THE OLDWAY” DFTHBNEEtJkQRMODERN f.ONG TERM CARDIOVASCULARMONkTOfUNO. ~ ,KTokbeva, G Com41isscn,K Akhmetov,M Teihlnom,F H~’rg, Hospitat#60, Moscow,Russia Morbidityend mortalitypatterns show the importance,with the circadian (CD), of abmtt-wcckty(circaseptan,CS) and about-hstfwcskfy(cbcaacmiseptan,CSS) hemodynanricrhyrJrmsberemappedin stageII hypwtensivepatients,beforestartingRx. Aimingfor 5 aatnpka par day during 7 consecutivedays (Monday m Sun&y) 36 patients provideddare from at kast 25 of 35 timepnims.Table 1 summarizes single and ppulation-mesn cosinors.The merits of further mapping CS aad CSS in additionto CD emergefrom the P-vatuesfrnm zernamplitude tests; double amplitudes (2A, measures of extent of pmzfictsblechangewitbinacycle);acmpbaacs (4, meaarm?ainnegative degtees of timingof overallhigh valuesrecurringin Wh cyck, with 3fjo0@@ OO=CO:C41 on Sun&y;andM, the (rhythm-adjusted) mean. Table 1:Abnut-wcekfy(CS),batf-weekly(CSS)anddaily(CD)cbmacteristicsofhemndytmmicvariablesin untreatedhypnension (stageff)= Cs Css CD M P 2A $ P 2A P 2A SBP 190.6 0.010 7.14 -3520.021 4,72 -2!5 <.00) 19.01 -? DBP 114.3 0.065 4.73 -3490.119 3,78 -313 <,001 7.19 .17 MAP 138.2 0.011 4,29 -20.063 2.30-239 <.001 10.64 -9 HR 66.60 0.301 1.09 -1670.025 1.71 -47 <.001 2,56-251 S1 36.09 0.1920.53 -2880.133 .676 -S9 0.132 .614 -263 MHV 4.159 0.721 .062 -212 0.036 ,152 .58 <031 .234 -255 CI 2.378 0.850 .026 -2200046 ,092 -57 <.001 .142 -257 TPR 2784, 0.149 105, -23 0.016 143, -241 <.001 299. 44 SPR 507.9 0.04724.0 -11 0,017 23.6-239 <.001 55.1 -39 w 1.157 0005 .040 -344 0,621 .010 -176 <.001 ,088-356 *S=systolic BP=blood pressure (mm Hg); DBP=diastolic BP; MAP=meanartcriaf BP; HR=heartrate (beata/min);Sl=strrrkeindex (ml/m2); MHV=minute heart volume (Ilmin); C1=csrdiac index (1/min/m2);TPR=tetal peripheral resistance (din.cm-s.see); SPR= specificperipheralresistance (din.cm-5.scc/m2);W=ttaeftdworkof the hear f.kgm),For patientsat high vaaculardiseaserisk in particular,the results show the need for automatic took to assess the broader hemodynamic time structures, notably of BP (for which now implamahledeviceshavebeenfunctioningbeat-to-beatforovera year, on the rightbut notyet on the left side of the circulation). abuut-hatf-weekly(circasemisepkm)rhythms,aboutKey Worda: weekly (circaseptan) rhythms, blood pressure, hemodynatnics
G60
G59 NONDIPPERHYPERTENSIVEPATfENTSANDAMBULATORY BLOODPRESSUREREPRODUCIBILITY fVR MI.&Q C. VergasaoJa,G. Garbero,G. Loffi.Hypertension Un~, Dept. of InternalMediune, San MartirrnHospital, Universityof Genoa Madical School, Genoa, Ifsly Purpose ofthastudy was to avaluafe the reproducibilityof ambulatory blood pressure monitoring(ABPM)in hypertensive patients under traafment. The rapmducibiiityof a normal or pathological circadian rhythm(i.a. ths prasencs of a nocturnal fall nf blcod pressure above or balow 10% vs daytima valuas) was assessed as well. 540 palients w“thessential hypertension undarwent ABPMtwice (internal 8-12 weeks). Patients were divided (depending on thair fall of nighttime BP) in: dippsrs (fall > 10% ofdayfima values, N=1B4),nondippers (fall. 10”A, N=12S)and intermediate (systolic alone or diastolic alona fall > 10%, N=228). Afterthe seccmd ABPM93 dippers wara confirmed,31 turned nondippare and BOturned intermediate; 36 nondippers were confirmed, 25 turned dippers and 87 turned intermediate; 11S intennediata wera mnfirmad, 52 turned dippers and = turnad nondippsrs Relationshipa among first and secnnd data eats were highlysignificant (r==.513 to r=0,&7, P
4 AJH-APRIL 1997-vOL.
ABPM,dipper, nondipper, rapmducibilify
EFFECTS OF AMLODIPfNEAND NIFEDfPfNE RETARD ON 24-HOUR BLOOD PRESSURE, HEART RATE AND AUTONOMIC NERVE ACTIVITIES IN HYPERTENSIVE PATIENTS. J Minami, Y Kawsno*, T Ishimitsu, and S Takishita. Division of Hypertension, National Cardiovascular Center, Suitn, Osaka, Japan, We evaluated the effects of l,4-dihydropyridine calcium antagonists with a different biological half-life, amlodipine and nifedipine retard, on 24-hour blood pressure (BP), heart rate (HR) and autonomic nerve activities inpatients with essential hypertension. Twenty hypertensive out-patients (14 women and 6 men; 63*2 yesrs, m+ SE) were enrolled in this study. Ambulatory BPand electrocardiogram were measured for24hourat intervakof 30 minutes using TM-2425 at control period, after 4 weeks of amlodipine administration (Aml: 2.5 mg or 5 mg once daily), and after 4 weeks of nifedipine retard administration (Nif: 10 mg or 20 mg twice daily). The order of the three periods were randomized. Autonomic nerve activities were evafuated by power spectral analysis of HR variability, using the high frequency (HF) component as an index of parasympathetic nerve activity and the ratio of the low frequency (LF) component to HF component (LF/HF) as an index of sympatho-vagal balance. Twenty-four-hour BP waa significantly decreased comparably by AmI or Nif (Aml: - 12.7k2,6/-5.6~l.4 mmHg, P< O.01/P< O.01; Nif: -15. 1*2.1/ -6.9?c1.5 mmHg, P< O,O1/P< O.01). HR did not change by Am], while it was significantly increased by Nif (+3.3* 1.2 bpm, P