Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population.

BACKGROUND: Although weekly variations with a peak on Monday have been reported in the incidence of cardiovascular events, few studies have investigated weekly variations in blood pressure (BP). METHODS: One hundred and thirty-five community-dwelling subjects had 24-h ambulatory BP monitoring for 7 days. We calculated the mean awake, asleep, morning (during the first 3 h after awaking) BP, and morning BP surge (mean morning systolic BP minus mean asleep systolic BP) for each day. RESULTS: Monday surge in BP was found in the awake and morning BP (awake BP: 128.8 +/- 15.4/79.1 +/- 9.2 v 131.5 +/- 16.3/80.7 +/- 10.0 mm Hg, P < 0.01, respectively; morning BP: 127.3 +/- 17.8/78.8 +/- 11.4 v 132.5 +/- 18.2/81.2 +/- 10.0 mm Hg, P < 0.01, respectively) but was not found in the asleep BP (112.7 +/- 18.3/68.4 +/- 10.7 v 113.1 +/- 17.6/68.7 +/- 10.5 mm Hg, P = NS, respectively). The morning BP surge on Monday was higher than on the other days of the week except for Tuesday (Monday: 19.7 +/- 13.3 mm Hg v Friday: 16.4 +/- 12.9 mm Hg, P < 0.05; v Saturday: 14.7 +/- 13.3 mm Hg, P < 0.01 v Sunday: 13.7 +/- 12.0 mm Hg, P < 0.01; v Wednesday: 15.5 +/- 14.3 mm Hg, P < 0.01). CONCLUSION: Morning BP surge was the greatest on Monday in a community-dwelling population. This may be in accord with clinical evidence that cardiovascular events more frequently occur in the morning on Monday.

Toward chronocardiologic and chronomic insights: dynamics of heart rate associated with head-up tilting.

As a step towards investigating the chronome (i.e. the inferential endpoints of chaos, trends and rhythms) of heart rate (HR) variability (HRV), we investigated whether the fractality or complexity of HRV is affected by a head-up tilting (HUT) test in the morning after an overnight fast. Spectral and non-linear analyses of HR were performed on data gathered during an 80 degrees passive HUT test in 15 men and 28 women 32.8 +/- 11.5 years of age. The non-linear endpoints included the scaling exponents alpha1 (<11 beats) and alpha2 (>11 beats), which indicate fractal properties, calculated with detrended fluctuation analysis, and the approximate entropy (ApEn), a measure of overall complexity. Passive HUT increased alpha1 (from 0.986 +/- 0.217 to 1.370 +/- 0.185; P = 0.0001), but did not alter alpha2 (from 0.925 +/- 0.110 to 0.958 +/- 0.130; P = 0.19). A slight but statistically significant decrease in ApEn was seen during HUT (from 1.114 +/- 0.131 to 1.013 +/- 0.197; P = 0.002). In the tilt-up position, there was a statistically significant negative correlation between alpha1 and ApEn (r = -0.490; P < 0.05). In both the supine and the tilt-up position, alpha1 was correlated weakly with HF (r = -0.343 and r = -0.322, respectively), and strongly with LF/HF (r = 0.557 and r = 0.795), respectively. There was also a negative correlation between ApEn and LF/HF (r = -0.406 and r = -0.357, respectively). alpha2 did not correlate with any spectral or non-linear measures of HRV. Short-term fractal properties and complexity of HR were lowered with orthostatic stress. Alterations of the autonomic activities could be partly responsible for these changes and await extension of such studies to assess the broad spectral element of HRV, that includes, with components of approximately 3.6 and approximately 10.5 s, cycles with very much lower frequencies, along the scales of hours and even years, that critically modulate the mislabeled (only relatively high- and low-frequency) components in the range of seconds or minutes.

Seven-day (24-h) ambulatory blood pressure monitoring, self-reported depression and quality of life scores.

OBJECTIVE: Effects of environmental conditions on blood pressure (BP) and heart rate (HR) variations as putative factors underlying the onset of vascular events. METHODS: BP and HR were monitored around the clock for 7 days on 54 residents from Urausu, Hokkaido, Japan. Daytime, night-time, and 24-h means served to identify dippers and non-dippers. Questionnaire-assessed depression and subjective quality of life were related to BP and HR by analyses of variance and linear regression. Statistical significance was at 5%. RESULTS: A circaseptan (about 7-day) component characterizes the 24-h mean and standard deviation (SD) of HR, and the daytime and day-night ratio of systolic BP. The SD of HR is higher on weekends and lower on Mondays and Thursdays. When awake, systolic BP is lowest on Sundays and the day-night ratio is optimal on weekends (Saturdays: 15.7 +/- 9.4%; Sundays: 14.0 +/- 13.2%). Depression was detected in 15 subjects, who had higher mean systolic and diastolic BP values (systolic BP: P = 0.028 Fridays, P = 0.021 Tuesdays; diastolic BP: P = 0.022 Mondays, P = 0.006 daytime Mondays) and a lower day-night ratio of diastolic BP (P = 0.012 Tuesdays, P = 0.005 Wednesdays, and P = 0.038 Thursdays). A depressive mood correlated positively with 24-h averages of systolic (P = 0.037) and diastolic (P = 0.030) BP. CONCLUSIONS: Depression (and subjective quality of life) can affect BP and HR variability. The results indicate the role that psychological factors may play in the pathogenesis of cardiovascular disease. Therapeutic implications are suggested for primary and secondary prevention.

Synchronous triple early cancers occurring in the stomach, colon and gallbladder.

We report an unusual case of synchronous triple early cancers of the stomach, gallbladder and sigmoid colon. The patient was a 70-year-old man. Gastrointestinal endoscopy at a medical check-up initially revealed early gastric cancer. A thorough preoperative investigation showed a gallbladder tumour and early colon cancer. Endoscopic mucosal resection was performed for the colon cancer. Microscopically, the specimen showed well-differentiated adenocarcinoma involving the submucosal layer. Distal partial gastrectomy (D1) and simple cholecystectomy with lymph node dissection were also performed. The histopathological diagnosis was well-differentiated adenocarcinoma in the stomach (T1, N0, M0; Stage IA) and poorly differentiated papillary adenocarcinoma (T1, N0, M0; Stage I) in the gallbladder. The patient was doing well with no evidence of recurrence 6 months after surgery.

[Heart rate variability analysis and neurobehavioral function in community-dwelling older people aged 75 or older].

BACKGROUND: Although heart rate variability (HRV) has been found to be associated with increased mortality in the elderly, the association of HRV and cognitive function and activity of daily living (ADL) capacity in the very elderly are not clear. METHODS: A sample of very elderly people (N = 138), aged 75 years and older, living in Urausu, Hokkaido, participated in this study. Participants were classified into three groups: normal, borderline, and dementia. Time and frequency domain measures of HRV were compared with behavioral and cognitive functions. RESULTS: HRV components, except for the LF/HF ratio, did not correlate with age in the very elderly. The LF component showed a statistically significant correlation with all the variables of behavioral functions. Most HRV components showed statistically significant and positive correlations with the flexibility of the back. The LF and LF/HF ratio were significantly lower in the dementia group than in the normal group. CONCLUSION: Although the meaning of the LF component is still controversial, we foundadefinite relationship between the LF component and behavioral functions. A positive relationship between most HRV components and the flexibility of the back may suggest that reduced flexibility leads to deteriorated cardiopulmonary function and reduced HRV. A further prospective study is needed to examine whether HRV and neurobehavioral functions are independent predictors of morbidity and mortality in very elderly people.

Weekly variation of home and ambulatory blood pressure and relation between arterial stiffness and blood pressure measurements in community-dwelling hypertensives.

Although blood pressure (BP) is a major determinant of pulse wave velocity (PWV), some treatments have independent effects on BP and arterial stiffness. Although both ambulatory BP (ABP) and self-measured BP at home (HBP) have become important measures for the diagnosis and management of hypertension, single day recordings may be insufficient for a proper diagnosis of hypertension or the evaluation of treatment efficacy. To evaluate weekly variations in BP using 7-day HBP and 7-day ABP monitoring and to determine the relation between arterial stiffness and BP measurements in community-dwelling patients with hypertension. We enrolled 68 community-dwelling hypertensive subjects in this study. Significant weekly variations in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found in the awake ABP data (p < .01, respectively), while no significant weekly variations in the asleep ABP or the morning and evening HBP data were observed. In untreated subjects, significant correlations were obtained between the brachial-ankle PWV and the average awake SBP, the average asleep SBP and the average SBP measured by HBP in the evening. In treated subjects, only the average SBP measured by HBP in the morning was significantly correlated with the baPWV. Differences in the weekly variations in BP were observed between HBP and ABP monitoring. In addition, the morning systolic HBP was not correlated with arterial stiffness in untreated subjects with hypertension but was correlated in treated subjects. Relations between the morning HBP and arterial stiffness might be attributed to morning surges in BP and/or trough levels of antihypertensive drugs.