Chronobiologically-interpreted ABPM reveals another vascular variability anomaly (VVA): Excessive pulse pressure product (PPP) updated conference report

To assess the risk associated with an Excessive Pulse Pressure Product (EPPP, where PPP = systolic blood pressure x heart rate / 100), PPP was determined from Chronobiologically and chronomically interpreted aroundthe- clock Ambulatory Blood Pressure Monitoring (CABPM) and related to outcomes in three different investigations, carried out in the Czech Republic, Japan, and Taiwan. In these three outcome studies, values of PPP above 100 were associated with a statistically significant increase in cardiovascular disease risk. As such, EPPP in a 7-day or longer around-the-clock record qualifies as a new Vascular Variability Anomaly (VVA), or, if it persists in a series of 7-day records, a Vascular Variability Disorder (VVD). Being the product of blood pressure and heart rate, EPPP is not independent from MESOR-hypertension. The extent to which EPPP may contribute additive cardiovascular disease risk to other VVDs will require larger outcome studies capable of separating the risk associated with each VVD. In any event, PPP offers itself as another harbinger of risk, as a gauge for the optimization of treatment by timing, and as a variable with a time structure of its own, differing in terms of components with long periods found in time series covering decades from concomitantly measured systolic and diastolic blood pressure and heart rate. Since cardiovascular disease risk is dramatically increased by the co-existence of several VVAs (up to 100% in a 6-year prospective outcome study), sole reliance on the mean without consideration of other VVAs can no longer be forgiven as ignorance and should rather be viewed as indolence, eventually even as criminal negligence.