Heart Science

What is CASP?

Central Aortic Systolic Pressure (CASP) 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. CASP has been shown to be a more predictive factor in the relation to strokes and cardiovascular events, than the brachial pressure or the pressure at the arm.

Know Your CASP

CASP – Central Aortic Systolic Pressure.

For more than a century brachial blood pressure has been the standard for measuring cardiovascular risk and hypertension. The latest most accurate method to get an individual’s blood pressure is measuring their central aortic systolic pressure (CASP). To measure an individual’s CASP in the past took a very expensive and invasive process by doing a cardiac catheterization until NOW. New to the market is a device that is accurate, affordable, non-invasive and simple enough to be used in a home or clinic setting.

Central Aortic Systolic Pressure (CASP), it has been shown in many studies to be the strongest independent risk factors for stroke, heart attacks and the likelihood of survival after such an event. This 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. CASP has been shown to be an important factor in the relation to strokes and cardiovascular events, more so than the brachial pressure or the pressure at the arm commonly

Figure: CASP- the pressure at the root of the Aorta (largest artery of the body) as it emerges from the heart

Latest Technology for Heart Health



Cafe study: Certain medication that effectively lowers brachial blood pressure may have an adverse effect on CASP.


Strong heart study: Central pressure more strongly relates to vascular disease and outcome than does brachial pressure.


Central or aortic pressure and clinical outcomes: Recently a number of studies have concluded that CASP or pulse pressure (PP) or both have invariably been shown to be more strongly related to vascular damage, target organ damage, cardio vascular outcomes and mortality, whenever they have been compared to brachial blood pressure in the same study. More trials are needed.


Nighttime blood pressure is the blood pressure: Office visit BP reading can suffer from “white coat syndrome” and be erroneously high and receive overtreatment or low and receive suboptimal treatment. However reliable that office visit Bp has been, we need to redefine. Definition of hypertension control on 24 hour and nighttime pressure on which to base our pharmacotherapy. Nighttime pressure more closely defines risk/ reward ratio of hypertension treatment.

www.cardiocasp.org/documents/Nighttime_Blood_Pressure_Is_Blood Pressure.pdf

Radial Augmentation Index (Rai) is a useful parameter for vascular aging: These findings indicate that simple and easily obtainable radial augmentation index is age dependent and could be a useful index in vascular ageing.

www.cardiocasp.org/documents/Journal_for_rAI normal_range.pdf

Reason study: Left Ventricular Hypertrophy (LVH) is affected more by central rather than peripheral hemodynamic changes. A low dose combination strategy is best at managing hypertension.


Central versus Ambulatory Bp in the prediction of all cause mortalities: Office central BP is superior to peripheral BP, Central pulse pressure better predicts mortality than ambulatory BP. Out of office BP is superior to out of office central BP


Focus on central aortic pressure and the results of drug intervention: Dr Brian Williams focus on central aortic pressure and results of drugs on central pressure to optimize treatment of the patient.


Validation of Sphymocor and Omron central blood pressure devices: Both devices underestimated central Systolic BP, but closely correlate to estimates of central BP via catheterization.


Central BP – opportunity for efficacy and safety of drugs: Non-invasive measurements of CASP may improve further efforts at both understanding drug benefit and uncovering potential drug safety issues.


Central versus Ambulatory blood pressure in prediction of all cause and cardio vascular mortalities: Office central bp is more valuable than office brachial bp in prediction of cardio vascular mortalities. Out of office brachial is a better predictor than out of office central pressure. Pulse pressure may be better predictor of all-cause mortality than 24 hour brachial BP.


General guideline of arterial pulse waveforms: Arterial pulse waveform explained


American Heart Association’s European perspective of central blood pressure: Dr Williams thinks Phenotype rather than Genotype is going to give us the answers


Repeatability: Indices of cardio vascular function using radial applanation tonometry demonstrates a high level of repeatability even when used by relatively inexperienced staff and has the potential to be included in routine cardio vascular assessments of patients.

www.cardiocasp.org/documents/pulse_wave_analysis _Vasc_Med_2007.pdf

Casp normal range graphs: Graphs that illustrate CASP and Rai normal ranges for men and women

www.cardiocasp.org/documents/CASP _rAI_chart.pdf

The Oxford Centre for Monitoring and Diagnosis in Primary Care (MaDOx) Report: Estimating central blood pressure and arterial stiffness in primary care using non-invasive automated pulse wave analysis.


Three US medical associations support noninvasive central blood pressure assessment: The National Medical Association (NMA), The Association of Black Cardiologists (ABC) and the Association of Minority Nephrologists (AOMN) have issued a joint statement. The associations have a strong history of advocacy for the United States’ 39 million African Americans.


American journal of hypertension: Indices of pulse wave analysis are better predictors of left ventricular mass reduction than cuff pressure.” American journal of hypertension 20, No. 4 2007, pp. 378-84.



Pulse wave analysis: from the basic sciences to clinical applications

Is there any additional prognostic value of central blood pressure wave forms beyond peripheral blood pressure?

Pulse wave analysis and arterial stiffness.

Noninvasive measurements of central arterial pressure and distensibility by arterial applanation tonometry with a generalized transfer function: implications for nursing.

Arterial stiffness and stroke in hypertension: therapeutic implications for stroke prevention.

Antihypertensive therapy and wave reflections

Analyzing the radial pulse waveform: narrowing the gap between blood pressure and outcomes.

Assessment of outcomes other than systolic and diastolic blood pressure: pulse pressure, arterial stiffness and heart rate.

Systolic blood pressure, pulse pressure and arterial stiffness as cardiovascular risk factors.

Central arterial pressure and arterial pressure pulse: new views entering the second century after Korotkov.

Pulse wave analysis and pulse wave velocity: a review of blood pressure interpretation 100 years after Korotkov.

Mechanical principles. Arterial stiffness and wave reflection.

Arterial pressure waveforms in hypertension.

Pulse wave analysis.

Aortic pulse wave velocity: an independent marker of cardiovascular risk.

Arterial stiffness and cardiovascular outcome.

The indirect assessment of arterial compliance in hypertension patients by tonometric sphygmography

Measurement of pulse wave “augmentation index (AI) “and its clinical application

Arterial stiffness and wave reflection in hypertension: pathophysiologic and therapeutic implications.

Pulse wave analysis in the assessment of patients with left ventricular assist device.

Large-artery stiffness, hypertension and cardiovascular risk in older patients.

Effect of antihypertensive agents on arterial stiffness as evaluated by pulse wave velocity: clinical implications

Mechanisms, pathophysiology, and therapy of arterial stiffness.

Arterial elasticity in cardiovascular disease: focus on hypertension, metabolic syndrome and diabetes.

Pulse Wave Velocity Is an Independent Predictor of the Longitudinal Increase in Systolic Blood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging

Noninvasive assessment of arterial stiffness and risk of atherosclerotic events.

Clinical value of the study of stiffness of arterial wall. Part I

Arterial hemodynamics and pulse wave propagation

Arterial compliance (stiffness) as a marker of subclinical atherosclerosis

Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease.

Influence of arterial pulse and reflected waves on blood pressure and cardiac function.

Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms.

Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform.