Mathematical model of cardiovascular disease risk based on Vascular Variability Disorders

Blood pressure (BP) values during ambulatory BP monitoring are mostly still interpreted conventionally in the light of the same fixed 24-hour, daytime and nighttime limits for all adults 18 years and older. We show that a chronobiologic approach taking into consideration the circadian characteristics of the BP waveform adjusted for gender and age enable a better estimation of cardiovascular morbidity and mortality risk. Apart from increased 24-hour mean values of BP (MESOR, short for Midline Estimating Statistic of Rhythm), an attribute of MESOR-hypertension (MH), altered patterns of variability in BP and heart rate (HR) are markers of cardiovascular disease risk. Screening for these Vascular Variability Disorders (VVDs) yields a refined diagnosis and prognosis regarding the risk of cardiovascular morbidity and mortality. It also serves as a guide for timed treatment (chronotherapy) when warranted. This chronobiologic approach based on ambulatory BP monitoring remains applicable to manual measurements taken at intervals from the time of awakening to bedtime, preferably with an added measurement around mid-sleep.