Chronobiologically-interpretedabpm reveals another vascularvariability anomaly (VVA): Excessive pulse pressure product(PPP) - updated conference report

To assess the risk associated with an Excessive Pulse Pressure Product (EPPP, wherePPP = systolic blood pressure x heart rate/100), PPP was determined fromChronobiologically and chronomically interpreted around-the-clock Ambulatory BloodPressure Monitoring (C-ABPM) 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 incardiovascular disease risk. As such, EPPP in a 7-day or longer around-the-clock recordqualifies 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 pressureand heart rate, EPPP is not independent from MESOR-hypertension. The extent to whichEPPP may contribute additive cardiovascular disease risk to other VVDs will requirelarger outcome studies capable of separating the risk associated with each VVD. In anyevent, PPP offers itself as another harbinger of risk, as a gauge for the optimization oftreatment by timing, and as a variable with a time structure of its own, differing in termsof components with long periods found in time series covering decades fromconcomitantly measured systolic and diastolic blood pressure and heart rate. Sincecardiovascular 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 withoutconsideration of other VVAs can no longer be forgiven as ignorance and should rather beviewed as indolence, eventually even as criminal negligence.