Circadian rhythm of double (rate-pressure) product in healthy normotensiveyoung subjects

The double product (DP), systolic blood pressure multiplied by heart rate, is a surrogate measure of myocardial oxygen demand and cardiac workload use d increasingly today in medicine. The double product is more strongly corre lated with left ventricular mass than the daily blood pressure mean. The pu rpose of this study was to describe the normative circadian pattern of the double product in healthy normotensive young adults. We studied 125 men and 75 women, 23.0 +/-3.3 (mean +/- SD) years of age, without medical history of hypertension and 24h ambulatory systolic/diastolic blood pressure mean c onsistently below 135/85 mm Hg. Subjects underwent ambulatory blood pressur e monitoring at 30-minute intervals for 48 consecutive hours once each seas on of the year, yielding 930 protocol-correct blood pressure and heart rate time series. Subjects maintained their usual routine of diurnal activity a nd nocturnal sleep and avoided use of over-the-counter and other medication . Circadian rhythmicity in the double product was established by population multiple-component analysis. The double product rose rapidly from the lowe st value, attained 3h before awaking from sleep at night, to a markedly ele vated level at the commencement of morning activity. The double product was highest in the afternoon, roughly 7h after the commencement of diurnal act ivity. In both men and women, the shape of the high-amplitude circadian rhy thm in the double product was best described by a complex model composed of three cosine curves having periods of 24h, 12h, and 6h. The 24h mean in th e double product of 8092.51 +/- 42.76 (mean +/- SD) in men was significantl y lower than that of 8353. 17 +/- 37.48 in women (P < .001). The circadian double amplitude of the rhythm was statistically significantly greater (P < .001) in men (50% of the 24h mean) than women (44% of the 24h mean). The d ouble product did not differ between seasons in women, but it did in men (P = .017) due to reduced heart rate in summer. The circadian pattern of larg e amplitude in the double product and its gender differences must be taken into account when using this variable to assess cardiac workload, risk of l eft ventricular hypertrophy, and efficiency of antihypertensive therapy.