Cusum-Assessed personalized hypotensive treatment surveillance

An optimization approach for essential circadian timing of treatment of high blood pressure, diagnosed as one of the described vascular variability disorders, VVDs, is presented that specifically lowers the MESOR (M=Midline Estimating Statistic Of Rhythm) without inducing any other VVDs, such as CHAT (Circadian Hyper-Amplitude [A] Tension). This has been achieved using Cumulative sums and parameter tests applied to half-hourly automatic around-the-clock measurements for weeks at a time or longer. Hypotensive treatment (Rx) with a popular drug, at the wrong time was associated with CHAT, while the same dose when given at another time to the same patient was beneficial by lowering the M while leaving the 2A unaffected. In conclusion it is best to guard against an iatrogenic, excessive blood pressure overswing, systolic and/or diastolic, and against inducing other VVDs. "First do no harm" by not flying blind, i.e., by adequate surveillance of ambulatory blood pressure and heart rate measurements and concomitant sequential process control combined with statistical parameter testing.