The need for recycling

In human data-gathering, it is an advance to look at circadian patterns, but without a view of the broader chronome of multifrequency rhythms and trends, the analogy to at least some of the water spilling from the midsection of Baron Münchhausen's horse still stands (as long as the information is not further recycled). It seems short-sighted to ask merely whether a given drug raises or lowers the blood pressure when strokes may be prevented by treating an excessive swing in blood pressure around seemingly acceptable 24-hour averages of pressure. The effect of a drug upon the mean is most relevant in the case of an established MESOR-hypertension, and elevation of the rhythm-adjusted mean, assessed from systematic measurements. The MESOR usually provides a more precise and more accurate estimate of location than the arithmetic mean. Dr. Kuniaki Otsuka has demonstrated a very high risk of ischemic stroke and nephropathy when MESOR-hypertension is complicated by a circadian amplitude of blood pressure above the 90th percentile of peers (34). Even for patients with a MESOR of systolic/diastolic blood pressure below 130/80 mmHg, an excessive circadian amplitude represents a high risk for these conditions (3; cf. also 34). Drug effects upon excessive amplitudes of circadian or circaseptan rhythms, demonstrated by Dr. Yoshihiko Watanabe (Proc. X National Symposium, Indian Society for Chronobiology, Pune, India, August 21-22, 1995), are also important for the prevention of strokes (see pp. 38-41).