REWARDS IN PRACTICE FROM CHRONO-META-ANALYSES RECYCLING HEART-RATE, ECTOPY, ISCHEMIA AND BLOOD-PRESSURE INFORMATION

Previously published average curves of heart rate and duration of isch emia in patients with coronary artery disease, studied while on placeb o or on treatment with either atenolol or diltiazem, are re-analysed f or the assessment of about-daily (circadian) and about-weekly (circase ptan) changes in these variables and of any treatment effect on rhythm characteristics. In addition to circadians, a circaseptan pattern cha racterizes the duration of ischemia in all three aforementioned study stages. Both drugs decrease the duration of ischemia, atenolol, but no t diltiazem, also affects the circadian amplitude and acrophase of thi s variable. A circaseptan pattern is also found for heart rate on plac ebo and on treatment with atenolol, but not with diltiazem. Both drugs lower heart rate and the circadian amplitude and 24-h standard deviat ion of heart rate, atenolol much more markedly than diltiazem. Circadi an and circaseptan rhythm characteristics and their alterations with t reatment serve to optimize treatment by timing its administration. Chr onobiologic surveillance of variables that are being readily monitored as-one-goes by modern implantable devices can also serve for the vali dation of the effectiveness of drug and electrical therapy. Rhythm alt erations, in turn, can provide the earliest warnings of an elevated di sease risk and lead to an improved diagnosis.