Incidence pattern and treatment of a clinical entity - Overswinging or circadian hyperamplitudetension (CHAT)

Systolic (S)and/or diastolic (D) circadian hyperamplitudetension (CHAT) is defined as a circadian blood pressure (BP) amplitude above the upper 95% prediction limit of clinically healthy peers, the amplitude being computed by the least-squares fit of a 24-hour cosine curve to the dam. On a population basis, CHAT is associated with an elevated risk of ischemic stroke and nephropathy. We show that CHAT occurs preferentially in patients with a MESOR (midline-estimating statistic of rhythm, a rhythm-adjusted mean) of BP intermediate between MESOR-normotension and MESOR-hypertension, as prior evidence suggests; and that CHAT can be corrected by pharmacologic or non- pharmacologic treatment. We recommend an initial 7-day ambulatory monitoring span (rather than a single 24-hour profile) for the individualized diagnosis of CHAT in practice.