What is central systolic pressure, and why is it important?

Central systolic pressure (CSP) is the pressure within the aorta and large arteries, which reflects the pressure exerted on organs like the heart, kidney and brain. It is more directly associated with cardiovascular events than peripheral brachial pressure (measured on the arm). Research, including a meta-analysis by Vlachopoulos et al. (2010), shows that central pressures are stronger predictors of cardiovascular events and all-cause mortality than brachial blood pressure.

Is there strong evidence supporting central systolic pressure as a superior measure of cardiovascular risk?

Yes, substantial evidence supports this. Multiple large-scale studies have shown that central systolic pressure is a better predictor of cardiovascular disease (CVD) risk compared to brachial blood pressure. Studies, such as those by Wang et al. (2009) and Cheng et al. (2013), confirm that central blood pressure is more closely related to target organ damage and long-term cardiovascular outcomes. These findings solidify the importance of central systolic pressure in cardiovascular risk management.

What non-invasive tools are available to measure central systolic pressure?

The BP+ machine by Uscom is a validated, non-invasive device designed to measure central systolic pressure using pulse wave analysis (PWA). It has regulatory approval from the TGA (Therapeutic Goods Administration) in Australia as a Class IIa medical device and FDA (Food and Drug Administration) clearance in the US. This machine was presented as a gold standard for central pressure measurement at the European Hypertension Association in 2024. The BP+ machine’s accuracy has been validated in clinical studies, such as those reported by Gotzmann et al. (2020).

Can this technology be applied in General Practice?

Yes, CardiAction integrates seamlessly into General Practice. It standardises BP measurement protocols and enhances clinical insights through reproducible, non-invasive central pressure measurements. By offering central blood pressure data and additional vascular health markers, it provides actionable information for assessing and managing cardiovascular risk, enabling GPs to make more informed treatment decisions.

What additional data does CardiAction provide beyond central systolic pressure?

CardiAction provides a comprehensive cardiovascular profile through pulse wave analysis, measuring several key parameters:

• Augmentation Index (AIx): Reflects arterial stiffness and large vessel aging.
• Augmentation Pressure (AP): Indicates the reflected pressure wave due to arterial stiffness and inflammation.
• Ejection Duration: Assesses myocardial health and valve function.
• Pulse Pressure: Relates to aortic stiffness and is also linked to cerebrovascular health and cognitive decline.
• Subendocardial Viability Ratio (SEVR): Based on the Buckberg equation, this provides insights into myocardial oxygen supply relative to demand.

These additional data points allow clinicians to assess cardiovascular health comprehensively and identify early signs of arterial dysfunction or aging.

How does CardiAction assist in managing patients with statin resistance or scepticism?

CardiAction’s augmentation pressure and aortic stiffness measures help identify patients with elevated arterial stiffness who may benefit from statin therapy. The reduction of the burden of oxidised cholesterol, which is implicated in arterial stiffness and plaque formation, has been proven to improve arterial flexibility and reduce cardiovascular workload. Statins play a significant role in reducing these oxidised lipids, and CardiAction helps clinicians make more precise treatment decisions based on real-time vascular health assessments.

Is there a role for CardiAction in understanding cholesterol and its effects on cardiovascular health?

Yes, CardiAction’s measurements of arterial stiffness, particularly through augmentation index and augmentation pressure, reflect the impact of oxidised cholesterol on the arterial system. The tool provides valuable information on the role of cholesterol in vascular health and assists in identifying patients who may require cholesterol-lowering interventions to improve vascular flexibility and reduce the risk of cardiovascular events.

How does CardiAction align with existing guidelines on cardiovascular risk management?

CardiAction enhances current cardiovascular risk management protocols by offering additional data beyond standard brachial blood pressure. It provides central pressure and pulse wave analysis, improving the precision of cardiovascular risk stratification and allowing for more personalised and effective interventions, in line with emerging research that central blood pressure is a superior indicator of cardiovascular outcomes.

Are the measurements provided by CardiAction reproducible?

Yes, CardiAction ensures consistent and reproducible results through standardised measurement protocols. This allows for longitudinal tracking of treatment effects and cardiovascular health, offering a reliable method for monitoring patient outcomes over time.

How does CardiAction contribute to patient outcomes?

CardiAction provides a deeper understanding of cardiovascular health by measuring central systolic pressure and key vascular parameters. This detailed cardiovascular profile enables more precise treatment decisions and early interventions, improving long-term outcomes for patients at risk of cardiovascular diseases. Early identification of arterial stiffness and myocardial dysfunction can lead to more targeted therapies and improved clinical results.

What should I do if the CardiAction Risk Indicator shows an elevated risk?

If the CardiAction Risk Indicator shows an elevated cardiovascular event risk, it is essential to refer the patient for further evaluation and potential interventions. Elevated augmentation pressure, aortic stiffness, or other markers measured by CardiAction can be early signs of vascular dysfunction, warranting timely medical intervention to reduce future cardiovascular events.

REFERENCES

Central Systolic Blood Pressure

• Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and eta-analysis. European heart journal. 2010 Aug 1;31(15):1865-71.
• Wang KL, Cheng HM, Chuang SY, Spurgeon HA, Ting CT, Lakatta EG, Yin FC, Chou P, Chen CH. Central or peripheral systolic or pulse pressure: which best relates to target-organs and future mortality? Journal of hypertension. 2009 Mar;27(3):461.
• Cheng HM, Chuang SY, Sung SH, Yu WC, Pearson A, Lakatta EG, Pan WH, Chen CH. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. Journal of the American College of Cardiology. 2013 Nov 5;62(19):1780-7.
• Cheng YB, Thijs L, Aparicio LS, Huang QF, Wei FF, Yu YL, Barochiner J, Sheng CS, Yang WY, Niiranen TJ, Boggia J. Risk stratification by cross-classification of central and brachial systolic blood pressure. Hypertension. 2022 May;79(5):1101-11.
• Park JS, Shin JH, Park JB, Choi DJ, Youn HJ, Park CG, Kwan J, Ahn Y, Kim DW, Rim SJ, Park SW. Central hemodynamics and the discrepancy between central blood pressure and brachial blood pressure. Medicine. 2022 Oct 7;101(40):e30484

Pulse Wave Analysis Technology

• Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton P, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königsten K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular Ageing - Moving from Bench towards Bedside. Eur J Prev Cardiol. 2023 Feb 4:zwad028. doi: 10.1093/eurjpc/zwad028. Epub ahead of print. PMID: 36738307.
• Cheng YB, Thijs L, Aparicio LS, Huang QF, Wei FF, Yu YL, Barochiner J, Sheng CS, Yang WY, Niiranen TJ, Boggia J. Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure. Hypertension. 2022 Mar 2:HYPERTENSIONAHA-121.
• Sluyter JD, Camargo Jr CA, Scragg RK. Ten-second central SBP variability predicts first and recurrent cardiovascular events. Journal of Hypertension. 2019 Mar 1;37(3):530-7.
• Gotzmann M, Hogeweg M, Seibert FS, Rohn BJ, Bergbauer M, Babel N, Bauer F, Mügge A, Westhoff TH. Accuracy of fully automated oscillometric central aortic blood pressure measurement techniques. Journal of hypertension. 2020 Feb 1;38(2):235-42.
• Townsend RR, Black HR, Chirinos JA, Feig PU, Ferdinand KC, Germain M, Rosendorff C, Steigerwalt SP, Stepanek JA. Clinical use of pulse wave analysis: proceedings from a symposium sponsored by North American Artery. The Journal of Clinical Hypertension. 2015 Jul;17(7):503-13.

Central Pulse Pressure

• McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. European heart journal. 2014 Jul 7;35(26):1719-25., Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. European heart journal. 2014 Jul 7;35(26):1719-25.
• Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. European heart journal. 2010 Aug 1;31(15):1865-71.
• Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016 Jan;67(1):183-90.
• Cheng YB, Thijs L, Aparicio LS, Huang QF, Wei FF, Yu YL, Barochiner J, Sheng CS, Yang WY, Niiranen TJ, Boggia J. Risk stratification by cross-classification of central and brachial systolic blood pressure. Hypertension. 2022 May;79(5):1101-11.
• Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W, Umans JG, Calhoun D, Howard BV. High central pulse pressure is independently associated with adverse cardiovascular outcome: the Strong Heart Study. Journal of the American College of Cardiology. 2009 Oct 27;54(18):1730-4.
• Wang KL, Cheng HM, Chuang SY, Spurgeon HA, Ting CT, Lakatta EG, Yin FC, Chou P, Chen CH. Central or peripheral systolic or pulse pressure: which best relates to target-organs and future mortality? Journal of hypertension. 2009 Mar;27(3):461.
• Cheng HM, Chuang SY, Sung SH, Yu WC, Pearson A, Lakatta EG, Pan WH, Chen CH. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. Journal of the American College of Cardiology. 2013 Nov 5;62(19):1780-7.

Augmentation Index and Augmented Pressure

• Azizzadeh M, Karimi A, Breyer-Kohansal R, Hartl S, Breyer MK, Gross C, Boutouyrie P, Bruno RM, Hametner B, Wassertheurer S, Burghuber OC. Reference equations for pulse wave velocity, augmentation index, amplitude of forward and backward wave in a European general adult population. Scientific Reports. 2024 Oct 5;14(1):23151.
• Desbiens LC, Fortier C, Nadeau‐Fredette AC, Madore F, Hametner B, Wassertheurer S, Agharazii M, Goupil R. Prediction of cardiovascular events by pulse waveform parameters: analysis of CARTaGENE. Journal of the American Heart Association. 2022 Sep 6;11(17):e026603.
• Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. European heart journal. 2010 Aug 1;31(15):1865-71.
• Chirinos JA, Kips JG, Jacobs DR, Brumback L, Duprez DA, Kronmal R, Bluemke DA, Townsend RR, Vermeersch S, Segers P. Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). Journal of the American College of Cardiology. 2012 Nov 20;60(21):2170-7.
• Weber T, Auer J, O'rourke MF, Kvas E, Lassnig E, Lamm G, Stark N, Rammer M, Eber B. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. European heart journal. 2005 Dec 1;26(24):2657-63.
• Li WF, Huang YQ, Feng YQ. Association between central haemodynamics and risk of all-cause mortality and cardiovascular disease: a systematic review and meta-analysis. Journal of human hypertension. 2019 Jul;33(7):531-41.
• Subendocardial Viability Ratio (Ikonomidis I, Makavos G, Lekakis J. Arterial stiffness and coronary artery disease. Current opinion in cardiology. 2015 Jul 1;30(4):422-31.

SEVR

• Xie H, Gao L, Fan F, Gong Y, Zhang Y. Research Progress and Clinical Value of Subendocardial Viability Ratio. Journal of the American Heart Association. 2024 Mar 19;13(6):e032614.
• Aursulesei Onofrei V, Ceasovschih A, Anghel RC, Roca M, Marcu DT, Adam CA, Mitu O, Cumpat C, Mitu F, Crisan A, Haba CM. Subendocardial viability ratio predictive value for cardiovascular risk in hypertensive patients. Medicina. 2022 Dec 22;59(1):24.
• Anyfanti P, Gkaliagkousi E, Triantafyllou A, Dipla K, Zarifis H, Arseniou P, Lazaridis A, Douma S. Noninvasive assessment of myocardial perfusion in different blood pressure phenotypes and its association with arterial stiffness indices. American Journal of Hypertension. 2019 May 9;32(6):557-63.
• Fan T, Li Y, Li M, Zhu N, Zhang C, Wang X. The correlation between subendocardial viability ratio and the degree of coronary artery stenosis in patients with coronary heart disease and its predictive value for the incidence of short term cardiovascular events. Coronary Artery Disease. 2024 Apr 8:10-97.
• Laugesen E, Hoyem P, Fleischer J, Kumarathas I, Knudsen ST, Hansen KW, Christiansen JS, Hansen TK, Poulsen PL, Reduced subendocardial viability ratio is associated with unfavorable cardiovascular risk profile in women with short duration of type 2 diabetes. Am J Hypertens (2016),29:1165–1172