Extended consensus on guidelines for assessment of risk and management of hypertension: A scientific statement of the international college of cardiology - thank you, Dr. Franz Halberg

In most of the guidelines by various agencies, a widespread belief exists that underlying usual blood pressure can alone account for all blood pressure related risk of vascular events and for the benefits of anti-hypertensive drugs. This view may not be correct because it does not consider total risk. Around-the-clock ambulatory blood pressure monitoring is necessary for at least 7 days to better assess risk related to blood pressure and blood pressure variability. Reference limits for blood pressure are currently based mostly on cohort studies and on controlled drug trials conducted among hypertensive patients. This must be changed. Using fixed limits for all adults 18 years and older (or in just 2 age groups) should be replaced by time-specified limits qualified by gender, age, and ethnicity, to be derived from clinically healthy populations, as done on too small a scale within the project on The Biosphere and the Cosmos (BIOCOS). This special paper highlights Vascular Variability Disorders (VVDs), which include, with MESOR-hypertension, Circadian Hyper-Amplitude-Tension (CHAT), ecphasia, ecfrequentia, excessive pulse pressure, excessive pulse pressure product, and a deficient heart rate variability. Anti-hypertensive drugs with their bioavailability as well as bioactivity have to be optimized by chronotherapy to improve benefit and reduce side effects, as documented by a great scientist and human being, Professor Franz Halberg, an exceptional, remarkable man, the father of chronobiology, who introduced the concepts of chronopharmacology and chronotherapy.