Fleeting 'Monitor-', 'Conflict-', or 'Grief-Associated' blood pressure disorders: MESOR-Hypertension and circadian rhythm

The blood pressure (BP) and heart rate (HR) of a clinically apparently healthy woman (CH) were ambulatorily monitored at 30-minute intervals on four occasions for spans of 21, 11, 11 and 15 days, separated by a few months, with a thorough diary kept on each occasion. The data were fitted by least squares with a 24-hour cosine curve according to the cosinor procedure. During the first 5 days of the first span and the first day of the second span, the rhythm-adjusted mean (MESOR) of BP was elevated with respect to time-specified limits (chronodesms) derived from data obtained around the clock from gender- and age-matched peers. For the first 3 days, the circadian BP acrophase, a measure of timing of overall high values recurring each day, was also deviant. A measure of the extent of daily rhythmic change (the circadian double amplitude, 2A), was within the corresponding chronobiologic reference standard on the first few days, but was occasionally excessive, notably on the day following a conflict or on a day of grief, the emotion recorded prospectively rather than by recall after the fact. A novelty (of monitoring) MESOR-hypertension is exhibited not only by CH but also by some others who were monitored for several days by us. In CH, but not in two other individuals, the monitor-associated MESOR-hypertension was accompanied by an alteration of the circadian acrophase, namely by a phase delay. In the first recording span only, also transiently, in the absence of an undue MESOR elevation, CH exhibited an excessive circadian BP amplitude, a conflict- or grief-associated circadian overswing (CHAT) of both SBP and DBP, which did not recur in the following recording spans, except for a DBP CHAT episode in the second session. A population study had indicated that overswinging is associated with a very high risk of ischemic stroke and nephropathy. A test of the consistency of overswinging is hence particularly important. In the patient examined, clear overswinging occurs only sporadically as a physiopathologic response to unusually burdensome events in everyday life. When the circadian double amplitudes are acceptable, however, they remain near the upper limit of the 95% prediction interval of peers. Overswinging can occur on days other than those associated with MESOR-hypertension and a circadian acrophase alteration. In CH, the latter two conditions may be associated with the nuisance and/or 'novelty' of ambulatory monitoring, they last for 5 and 3 days, respectively, in the first session and a MESOR elevation is seen only on the first day in the second session, and no deviations are seen in two subsequent profiles.