Circadian hyper-amplitude-tension (CHAT): A disease risk syndrome of anti-aging medicine

Serial measurements, taken around the clock in the laboratory and clinic, can be analyzed by computer-implemented curve-fitting to assess the approximate 24-hour (circadian) variation, among other rhythmic and chaotic components of the time structure (chronome) of any variable. This approach is particularly important to quantify blood pressure variability, which renders even the most accurate single measurement into a snapshot on a roller coaster. A seemingly acceptable blood pressure can be particularly misleading when accompanied by the recommendation of another check-up in 2 years, which is the official position of the World Health Organization. An overswinging of the blood pressure along the 24-hour scale may then be missed. This excessive circadian amplitude, called "circadian hyper-amplitude-tension" (CHAT), constitutes a new disease risk syndrome, warranting screening, diagnosis, and treatment. With or without the midline-estimating statistic of rhythm (MESOR) (i.e., the [chronome-adjusted] mean value), the circadian double amplitude, a measure of the extent of predictable change within a day, is a predictor of vascular disease risk. An excessive amplitude (above the upper 95% prediction limit of healthy peers matched by age, gender, and ethnicity) is associated with an elevated left ventricular mass index in a retrospective chrono-meta-analysis of data from 424 patients and with an increase in morbid events in a prospective 6-year study on 297 patients, following-up on ancillary clinical studies and on results obtained on the laboratory model of the stroke-prone spontaneously hypertensive rat. CHAT is associated with a 720% increase in risk of ischemic cerebral events. It represents the greatest increase in risk, compared with 310%, 370%, 160%, 170%, and 150% in relation to a high blood pressure, old age, a family history of high blood pressure, and/or of other vascular disease, smoking and alcohol consumption, respectively. To identify CHAT and for other diagnostic and therapeutic reasons, single measurements should be replaced by an around-the-clock profile, for a week or longer, if need be, at the outset. The profile is preferably obtained by automatic monitoring with ambulatorily functional instrumentation. When such a monitor is unavailable, self-measurements at 3-hour intervals during waking and one around midsleep are acceptable. The midsleep measurement is taken with minimal disturbance, preferably by a companion, while the patient sleeps with a cuff on the arm. When no companion is available, the patient can set an alarm clock to take the self-measurement. Treatment should be timed with individualized guidance by a blood pressure profile (chronotherapy). The same profile also serves to assess the treatment effect with a control chart to validate the reduction of an excessive amplitude, the lowering of the blood pressure, or both when elevated. Controlled clinical trials assessing long-term outcomes are overdue. By monitoring for only weeks, the recognition and treatment of blood pressure overswinging along the 24-hour scale - a must in anti-aging medicine - may prevent postcatastrophic care for years.