Vascular variability disorders in the middle east: Case reports

Most care providers currently ask, based on an office visit or on a 24-hour Ambulatory Monitoring of Blood Pressure (BP) (ABPM) and heart rate (HR), whether a person's systolic (S) and/or diastolic (D) BP is too high, too low, or acceptable. This practice implies that a true time-invariant BP can be diagnosed with single measurements that can be checked in the case of doubt by a 24-hour record, believed to be a representative platinum standard. On this basis, and in the light of target values applied irrespective of gender to adult males and females, without further considering their age, a diagnosis may be reached that prompts antihypertensive treatment. The therapy may then be continued, perhaps for a lifetime. Once the diagnosis of a high BP is made, treatment is usually not stopped to check and see whether it is needed. In this era of spotcheck medicine, progress has been made with Austrian guidelines that require 30 measurements before a diagnosis is made [1, 2]. As yet, the timing of these measurements is not specified and a chronobiologic diagnosis is not required. Alternatives based on systematic monitoring, long advocated [3-10], can now be implemented with new measurement and analytical tools. We advocate a record of half-hourly or denser around-the-clock data covering 7 days at the outset. To document the need for our suggestion of a Chronobiologically-interpreted (C-) 24-hour/7-day ABPM (C-ABPM), we present two case reports from Al-Ahsa, Saudi Arabia, showing a great variability from day to day. In a chronobiologically-interpreted set of time series of 12 Saudi individuals, we detected two cases with BP excess by stacking along the 24-hour scale for a comparison of their data with those of peers of the same gender and similar age [6, 7]. In one case, by a model-dependent approach, we also found MESOR- hypertension, i.e., an elevated Midline-Estimating Statistic Of Rhythm (MESOR, M).