Individual assessment of antihypertensive response by self-starting cumulative sums

Abstract

A self-interpreted control chart, on an individualized basis, assesses the effect of a switch from beta-blockers to an angiotensin-converting enzyme (ACE)-inhibitor in a patient with occasional blood pressure (BP) excess. In dense and long data series, the BP and heart rate (HR) of this patient respond to the change in treatment by the test criterion of a self-starting Cumulative Sum (cusum), which reaches values outside a decision interval with a lowering of BP and an increase in HR and vice versa, at least for BP, after treatment cessation. Thereafter, minimal sampling requirements are sought in the same data by applying the same control chart approach to decimated data. Skeleton sampling schemes in a system of chronobiologic self-analysis and interpretation of manually recorded data obtained at strategically placed times (established on the basis of data decimations) could complement control charts that are used on a home computer or preferably would be built into the output of ambulatory monitors used at the outset as a minimum and routinely as an optimum.