Research

A-PULSE CASP® Software

This patented, FDA-approved software used in conjunction with the BPro® device measures the Central Aortic Systolic Pressure (CASP) of a patient in five minutes. It has been validated in more than 10,000 patient waveforms non-invasively with a correlation R= 0.996. It has also been validated by direct measurement of CASP directly at the root of the aorta, using the Miller’s catheter in 2,000 patients’ waveform. The co-relation is R= 0.9917.

A-PULSE CASP® is designed to measure the CASP in a simple clinic or Pharmacy setting. The BPro device is used, together with a computer or laptop, using a USB port. It gives real time recording of the arterial waveforms which can be replay at any later time for further study. Another strong feature of A-PULSE is the ability to compare the various waveforms on different dates of the same patient, or different patients. All the parameters including the CASP are displayed instantaneously, the waveforms superimposed for comparison.

The A-PULSE CASP® is the only device that can measure the CASP in a clinic setting, easy to use and accurate. It is the evidence-based approach to the management of hypertension.

BPro® Radial Pulse Wave Acquisition Device

1. The use of ambulatory tonometric radial arterial wave capture to measure ambulatory blood pressure: the validation of a novel wrist-bound device in adults, Journal of Human Hypertension advance online publication, 8 November 2007; doi:10.1038/sj.jhh.1002306

Pulse Waveform Clinical Papers

1. Bryan Williams, Pter S. Lacy. Differential impact of blood pressure – Lowering drugs on Central Aortic Pressure and clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFÉ) Study. America Hearts Association, Feb 13, 2006

2. Athanase D. Protogerou, Theodore G. Papaooannou. Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target? Journal of Hypertension, 2007

3. Nicola de Luca, Jean-Michel Mallion. Regression of Left Ventricular Mass in Hypertensive Patients Treated with Perindopril/Indapamide as a First-Line Combination. The REASON Echocardiography Study. 2004 by American Journal of Hypertension.

4. Mary J. Roman, Richard B. Devereux. Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The String Heart Study. Hypertension 2007.

Central Aortic Systolic Pressure Clinical Papers

1. Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure, The Strong Heart Study, 
Mary J. Roman, Richard B. Devereux, Jorge R. Kizer, Elisa T. Lee, James M. Galloway, Tauqeer Ali, Jason G. Umans, Barbara V. Howard 
Hypertension 2007;50;197-203; originally published online May 7, 2007;
DOI: 10.1161/HYPERTENSIONAHA.107.089078
Hypertension is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX
72514
Copyright © 2007 American Heart Association. All rights reserved. Print ISSN: 0194-911X. Online
ISSN: 1524-4563

2. Regression of Left Ventricular Mass in Hypertensive Patients Treated With Perindopril/ Indapamide as a First-Line Combination
, The REASON Echocardiography Study, 
Nicola de Luca, Jean-Michel Mallion, Michael F. O’Rourke, Eoin O’Brien, Karl-Heinz Rahn, Bruno Trimarco, Ramon Romero, Peter Wilhelmus De Leeuw, Gerhart Hitzenberger, Edouard Battegay, Daniel Duprez, Peter Sever, and Michel E. Safar, on behalf of the REASON Project* 
doi:10.1016/j.amjhyper.2004.03.681

Background: Increase in left ventricular mass (LVM) may be linked to morbidity and mortality in hypertensive patients. Arterial stiffness, systolic blood pressure (BP), and pulse pressure (PP) seem to be the main determinants of LVM. The perindopril/indapamide combination normalizes systolic BP, PP, and arterial function to a greater extent than atenolol. The aim of this study was to compare the effects of perindopril (2 mg)/indapamide (0.625 mg) first-line combination with atenolol (50 mg) on LVM reduction in hypertensive patients.

3. Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target?
 Athanase D. Protogeroua,b, Theodore G. Papaioannoub, Jacques Blachera, Christos M. Papamichaelb, John P. Lekakisc and Michel E. Safara 
Journal of Hypertension 2007, 25:265–272

It is well established that in young and healthy individuals central (aortic or carotid) systolic and pulse pressures are different from peripheral (brachial) corresponding pressures as a consequence of progressive changes in arterial stiffness and pressure wave reflections along the arterial tree. There is evidence indicating that in interventions with pharmaceutical and non-pharmaceutical agents, central pressures are subjected to greater changes than peripheral pressures, and they are more closely related to the pathophysiology of end-organ damage or cardiovascular risk. Therefore central blood pressures may be of higher clinical importance than peripheral pressures. The present review aims to provide an insight into the (patho)physiology of central blood pressures, to present the most accurate techniques for their estimation, and to discuss the available experimental and epidemiological data that support the emerging need for the evaluation of central blood pressures in clinical practice. J Hypertens 25:265–272 Q 2007 Lippincott Williams & Wilkins.

4. Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes
Principal Results of the Conduit Artery Function Evaluation (CAFE) Study


The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators
CAFE Steering Committee and Writing Committee: Bryan Williams, MD, FRCP; Peter S. Lacy, PhD; Simon M. Thom, MD, FRCP; Kennedy Cruickshank, MD; Alice Stanton, MB, PhD, FRCPI; David Collier, MBBS, PhD; Alun D. Hughes, MBBS, PhD; H. Thurston, MD, FRCP
Study Advisor: Michael O’Rourke, MD, FRACP 
Circulation 2006;113;1213-1225; originally published online Feb 13, 2006;
DOI: 10.1161/CIRCULATIONAHA.105.595496

When blood pressure is measured conventionally over the brachial artery, it is assumed that these measurements accurately reflect pressures in the central circulation. This assumption is supported by irrefutable observations that brachial blood pressure parameters are powerful predictors of cardiovascular structural damage, morbidity, and mortality.1 However, central aortic pressure parameters and left ventricular load are determined not only by cardiac output and peripheral vascular resistance but also by the stiffness of conduit arteries and the timing and magnitude of pressure wave reflections.2–6 Short-term studies have shown that various classes of blood pressure–lowering drugs may have profoundly different effects on pulse wave morphology and thus central hemodynamic parameters despite similar effects on brachial artery pressures.7–11 This observation is relevant to the debate about how much of the benefit of blood pressure–lowering drugs in clinical trials can be attributed to blood pressure lowering per se or to alternative mechanisms “beyond blood pressure.”12 This debate is fundamental because it defines the principles of clinical practice for the treatment of hypertension.