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15th
World Congress Clinical Nutrition
19th
– 22nd September 2010 El Sokhna Resort - Egypt
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Copyright © 2010.
WCCN2010.COM
All rights reserved |
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The diagnostic value of the
sphygmochron in the early diagnosis
of pre-hypertension and hypertension
*Sergei Chibisov, *R Agraval, **G
Cornelissen,*E Kharliskaya , **F
Hallberg
*People's Friendship University of
Russia, Moscow, Russia ; **Halberg
Chronobiology Center, Univ
Minnesota, Minneapolis, MN, USA |
Introduction : The
likelihood of stroke or cardiac
death can be immediately reduced by
chronobiologically assessing blood
pressure and heart rate variability
and by optimizing the efficacy of
timed treatment rather than relying
on an unacceptable and often
inaccurate spotcheck and treating by
convenience rather than pertinence.
Needed are: detection of nocturnal
abnormality when medication may no
longer be effective (or is too
effective) neither seen during
office visits by day; detection of
circadian hyperamplitude-tension
(CHAT) associated with a risk of
stroke and kidney disease greater
than other risks (including
“hypertension” when all risks are
assessed concomitantly); detection
of CHAT as high risk among
normotensives who may not need
anti-hypertensive medication;
individualized inferential
statistical testing to determine
whether a drug or non-drug
intervention such as autogenic
training (relaxation) is effective
and for how long (detecting any
initial and later success or
failure), some of which conditions
otherwise are not found without
chronobiology; individualization of
treatment timing, since the same
dose of the same medication can
further lower the subject's blood
pressure average and circadian
amplitude when the timing of daily
administration is optimized, as
ascertained by sequential testing
and parameter tests.
Method A
19-year-old female student provided
two 7-day profiles of automatic
around-the-clock blood pressure and
heart rate measurements at 30-minute
intervals, assessed
chronobiologically by sphygmochron,
allowing a comparison of the cosinor
with a classification by dipping .
The former, but not the latter, are
consistent on a weekly basis, in
keeping with earlier results. Once
abnormality is detected, continuous
vascular monitoring is indicated.
Results from a second monitoring
revealing a diagnosis of both
systolic and diastolic CHAT. The
extent of day-to-day variability is
visualized in Figures 4A-E and 5A-C
for the chronobiologic approach and
in Figure 5D for the DNR. Moreover,
by expressing changes in acrophase
and amplitude in one number, the DNR
cannot differentiate between changes
in different parameters. In the
second profile as in the first
profile, the DNR is not consistent.
It may mislead, being normal in a
person who is clearly abnormal.
Discussion While the evidence from
population studies with outcomes as
morbid
events or with a proxy outcome, the
left ventricular mass index, deals
with hundreds and thousands of
patients, even relatively small
studies sufficed to demonstrate that
the sphygmochron can distinguish
pre-diabetes from normoglycemia when
the DNR fails to do so, and can
actually mislead in
pre-hypertension, the overall DNR
misleads again. Figure 3D is
particularly persuasive in showing
that the current platinum standard,
the 24-hour profile, is
unsatisfactory: that is, it is
misleading when after an acceptable
result on the first day, all six
subsequent daily results show
abnormality. That even monitoring
for 2, 3 or 4 days does not predict
outcomes has also been shown.
Conclusion Diagnoses,
whether by DNR or sphygmochron, on
consecutive days can vary greatly
and can lead to different diagnoses
with the DNR which confounds changes
in phase and amplitude. The
diagnoses based on the sphygmochron
are more consistent and overall do
not mislead as the overall DNR did
in this case in one of two profiles.
References
1. Halberg F, Cornélissen G, Wall D,
Otsuka K, Halberg J, Katinas G,
Watanabe Y, Halhuber M, Müller-Bohn
T, Delmore P, Siegelova J, Homolka
P, Fiser B, Dusek J, Sanchez de la
Peña S, Maggioni C, Delyukov A,
Gorgo Y, Gubin D, Carandente F,
Schaffer E, Rhodus N, Borer K,
Sonkowsky RP, Schwartzkopff O.
Engineering and governmental
challenge: 7-day/24-hour
chronobiologic blood pressure and
heart rate screening. Biomedical
Instrumentation & Technology 2002:
Part I, 36: 89-122; Part II, 36:
183-197.
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