M.V. Voitikova – Ph.D. (Phys.-Math.), Leading Research Scientist, 

Institute of Physics, National Academy of Sciences (Minsk, Republic of Belarus) voitikova@imaph.bas-net.by, m.voitikova@dragon.bas-net.by

R.V. Khursa – Ph.D. (Med.), Department of Polyclinic Therapy, Belarusian State Medical University (Minsk) Rvkhursa@tut.by

This article provides a performance analysis of the hemodynamic nomogram, a new diagnostic tool in hemodynamics based on regression modeling of ambulatory blood pressure monitoring data (ABPM). We hypothesized that the correlation between systolic, diastolic and pulse pressure can be a measure of individual homeostatic features of the human cardiovascular system. The diagnostic nomogram was created by discriminative Support Vector Machine-classifier, that separate the ABPM parameters of hypertensive, normotensive or hypotensive patients. According to the proposed diagnostic method, regression coefficients of ABPM of the tested patient is represented as a point on the nomogram, indicating up to 10 hemodynamic phenotypes of diastolic, harmonic and systolic hemodynamics. The nomogram was implemented separately for the 24-hour and daytime ABPM recordings.

Application of nomogram in clinical practice in the real-time devices can provide new insight in the patient’s hemodynamic phenotype; support the decision making on customized antihypertensive therapy based on specifics of blood circulation; prognosticate for hypertonic patient; detect the latent hemodynamic disorders, when users are not aware to prevent arterial hypertension; appraise the effectiveness of physiotherapy, that affects the hemodynamic characteristics and phenotype during rehabilitation; retrace the changes in ABPM parameters due to the antihypertensive therapy. Furthermore, our results have prompted discussion on whether antihypertensive treatment should be targeted only towards reducing mean BP level, but also to examine the hemodynamics with the aim of cardiovascular protection. 

We have investigated the classification capability of the nomogram, limitations of linear modeling, as well as the cardiovascular phenomena described. Missclassification can be understood by the nonlinear properties of the dysfunctional diastolic hemodynamics. It was shown that the patient’s hemodynamics of a harmonic type, being weakly non-linear, can be adequately described by the non-stationary linear stochastic process, in contrast of the hemodynamics of the dysfunctional diastolic type. On the nomogram the hemodynamics of the dysfunctional diastolic type is essentially nonlinear, partially overlapping of the hemodynamic states of hypertensive and normotensive patients is possible. In other words, the linear regression modeling of ABPM has low cost of error for harmonic hemodynamics, but in case of hemodynamics of the dysfunctional diastolic type it is necessary to appraise the entropy or some statistical parameters of ABPM.

Voitikova M.V., Khursa R.V. Possibilities of hemodynamic states classification by linear regression modeling of blood pressure parameters. Technologies of living systems. 2020. V. 17. № 3. P. 34–45. DOI: 10.18127/j20700997-202003-04 (In Russian).

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