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Why Is Central Aortic Systolic Pressure Important?
 

Hypertension, or more commonly known as high blood pressure, affects about 1 billion people globally. If such condition does not receive attention and is not treated appropriately, disastrous consequence could happen. This is because hypertension can eventually lead to other medical conditions including stroke, heart disease and kidney failure.

Data from the World Health Organization (WHO) showed that some 17 million people around the world die every year of cardiovascular disease, particularly heart attack and stroke. Cardiovascular disease is also the leading cause of death in Singapore and it accounted for nearly a third of all deaths in 2008.

The conventional method of identifying a hypertensive patient is to measure the blood pressure at the brachial artery (pressure at the arms). The blood pressure reading is usually expressed in terms of the systolic pressure and diastolic pressure (mmHg), for example 120/80 (systolic/diastolic readings). When the patient's blood pressure readings reaches or exceeds 140/80, he or she is said to be hypertensive.

This type of measurement might accurately determine diastolic blood pressure, but it might not reflect the systolic blood pressure accurately. The reason behind this is that the blood pressure waveform, and so is the systolic pressure, is distorted when it travels outward from the heart. As a result of such distortion, blood pressure measured in the brachial artery provides an inaccurate measure of central aortic systolic pressure (CASP).

Here comes the question, what is CASP? It is the blood pressure at the root of the aorta or the largest artery in the body, as the blood is being pumped out of the heart. Scientists believe CASP is more closely related to cardiovascular disease (heart disease and stroke) than the brachial pressure.

For a normal person, the CASP is different and usually lower than the brachial pressure. The difference between CASP and the brachial pressure for younger people (below 40 years old) can be significant, say up to 30 mmHg. The aorta, however, becomes stiffer for older people. This could increase CASP and make it closer to the brachial pressure. It should be noted that hypertensive patients could have abnormally high CASP for their ages, indicating a possible pre-mature stiffening of the aorta.

On the other hand, studies have shown that certain types of medication to treat hypertension could actually increase instead of lowering the CASP. Therefore, doctors should ensure the medications prescribed to treat hypertensive patients should lower their CASP instead otherwise. Bear in mind that lowering the CASP could reduce the risk of getting stroke and heart disease.

If CASP is so important, then why it is not commonly used to determine and monitor hypertension? One simple reason is that there was no device that is affordable and simple enough to accurately measure CASP at home or in clinic. Current practice to measure CASP is to employ technique, which is either an invasive angiographic measurement or a very expensive and cumbersome system, only used in research laboratories.

A Singapore company, HealthSTATS (HS), has developed a so-called A-Pulse CASP, which is a software works with a watch-like device known as BPro to record waveforms from the arteries. The software allows non-invasive reading of CASP, and was tested and validated in 3 separate clinical studies involving 12,000 patients. In June 2010, the United States Food and Drug Administration (FDA) approved the CasPro, meant for GP (General Practice) clinics, and CasPal, meant for use at home.

Save 1 Heart, an American firm that tests for and treats heart disease, confirmed that some 50,000 Native Americans will use these devices, as part of a large-scale trial to track how such measurements are associated with diabetes.

It is understood that some pharmaceutical companies have used the new devices to test whether their new blood pressure drugs are working. Meanwhile, the new inventions have also been introduced to hospitals and clinics in Singapore for research, health checks as well as treatments.

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