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.
Bibliographical noteFunding Information:
Chronobiology Center, University of Minnesota MMC 8609, 420 Delaware Street SE, Minneapolis, MN 55455, USA b Tokyo Women "s Medical University, Medical Center East, Tokyo, Japan c Masaryk University, Brno, Czech Republic d Halberg Hospital and Research Institute, Moradabad, India e Government Medical College, Amritsar, India f King George's Medical University, Lucknow, India g lMSSfor Escuela Nacional de Medicina y Homeopatma, IPN Mexico City, Mexico h Centre de Diabetes A.C., Mexico City, Mexico i San Jose State University, CA, USA J Shandong Academy of Medical Sciences, Jinan, China k The Chinese University ofHong Kong, Hong Kong 1 Comenius University, Bratislava, Slovakia
- Blood pressure
- Chat (circadian hyper-amplitude-tension)
- Glucose intolerance
- Worldwide incidence