A Collective Study performed on Asian Chinese Normotensive Population

to Obtain Healthy Normal Range of some Waveform Indices

Background—Arterial blood pressure waveforms contain rich pathophysiological

information of the cardiovascular system where they are more than just numerical digits of
indices. This information includes indices describing left ventricular systolic function and
arterial properties such as the conventional systolic blood pressure (SBP), diastolic blood
pressure (DBP) and pulse rate (PR) which have been validated with a set of range as a guide
to aid monitoring of the blood pressure. Fiducial points of arterial blood pressure waveforms
such as the onsets, systolic peaks and dicrotic notches are important points of the arterial
blood pressure waveform and such information would serve as a better reflect one’s health
condition. Thus with these information, a new set of additional indices such as central aortic
systolic pressure (CASP), systolic upstroke gradient (SUG), systolic cycle and ratio of net
area (RNA) may serve a basis of assessment of one’s health.

Methods and Results—We conducted a study using BPro®, a validated US FDA (510k no.:
k060315) approved device, which is connected to a laptop with an A-PULSE CASP software
that has been clinical validated and approved by the regulatory authorities, US FDA (510k
no. : k072593). A total of 2157 Asian subjects comprising of 1036 females and 1121 males
participated in this study. The subjects were drawn from Singapore and China provinces such
as Beijing, Shanghai and Xi An. With the collected data, simple scatter plots of the
distribution of the various indices for normotensive people were drawn across the age group.
After which, linear equations were determined using linear regression analysis and 95%
confidence interval denoting the reference range for normotensive population for the various
indices. These graphs were plotted using SPSS 13.0 and Microsoft Office Excel 2003.

Conclusions—The ability to express waveform indices in terms of numbers not only aid in
the determination of the effects of drugs and other interventions, reference ranges and trends
have been generated to monitor and aid in improving the quality of our health. Through this
study, we highlight CASP, SUG, systolic cycle and RNA with brief analysis and their
reference ranges. Currently, there has already been a shift to include CASP measurements
and reference ranges in a few guidelines for hypertension. Hence, it is hoped that more
outcome studies and trials may be conducted to seek greater relevance and correlations of
these waveform indices to our health. Therefore in future, we seek to attach weightage to
these waveform indices to generate a composite index. And with this impactful composite
index comprising of all the important indices, we are able to obtain a more accurate indicator
of our cardiac health.

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Introduction
Blood pressure monitoring systems today has become an invention that not only presents
digital values but a wealth of cardiovascular information. Recent developments in arterial
hemodynamics suggest that the human arterial pressure waveform contains more information
than conventional sphygmomanometry provides [1]. This information includes indices
describing left ventricular systolic function and arterial properties besides the conventional
indices such as systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate
(PR), additional indices include central aortic systolic pressure (CASP), systolic upstroke
gradient (SUG), systolic cycle and ratio of net area (RNA).
The morphological characteristics of an arterial blood pressure (ABP) waveform are closely
related with the hemodynamic behaviours of blood circulation. Its onset and steep upstroke
(Figure 1a) is attributed to aortic valve opening for blood ejection. It is followed by systolic
peak reflecting the integrated behaviours of cardiac blood ejection and arterial wave
reflection [2]. After which, there is generally a dicrotic notch indicating the closure of aortic
valve before blood runoff in vasculature. The waveform contour contains plenty of useful
information. With analysis of the waveform, the function of the heart and the stiffness of the
arterial tree may be predicted. With the value of SUG reflecting the systolic upstroke
gradient and Systolic Cycle showing the percentage of period of systole over the entire cycle,
both indices are important indicators of the heart function.

Figure 1: Synthetic ABP waveforms and their derivatives

Systole Diastole

Dicrotic Notch

A
B

Figure 2: Radial pressure waveform

As shown in the Figure 2, the dicrotic notch divides a heart cycle into systolic and diastolic
period. RNA reflects the ratio of net area A over net area B.
CASP which is the pressure at the root of the aorta, the biggest artery in the human body
leading away from the heart, has showed evidence to be more relevant to cardiovascular
diseases than brachial BP [3, 4]. Furthermore, there have been shifts in many countries to
amend medical guidelines to include CASP measurement.

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Over the years, waveform analysis has been extensively studied and with the accuracy of
capturing these graphical recording of the heart cardiac cycle, pulse waveform measurements
are easily obtained and readily available. However, these waveform indices are not regarded
with importance as compared to the brachial BP measurements which are used in
identification of hypertension. It has only been in recent years that some countries are
including CASP measurement into the guidelines for hypertension. This shift suggests the
possibility of including other waveform indices that constitute the vital components of one’s
pulse waveform into the assessment criteria of one’s health. As such this review will present
and discuss the trend and reference ranges of these waveform indices.
In addition, with comparable evidence that differences in both the physical and mechanical
properties of the arterial tree between men and women potentially influencing the
relationship between peripheral and central waveforms [5, 6, 7], and corresponding studies
that demonstrated differences in measured central aortic waveform parameters between men
and women [8], it may potentially have clinical value to characterize these normal ranges
between men and women.

Objectives
Our main objective is to highlight the importance of these waveform indices (CASP, SUG,
systolic cycle and RNA) and discuss their normal reference ranges that may potentially be
integrated into the assessment of cardiac health. Furthermore, the differences in these indices
between male and female will also be examined.

Methods
A BPro® blood pressure monitoring device is connected to a laptop with an A-PULSE CASP
software programme to capture pulse waveform. The BPro® device has been clinically
validated and approved by the regulatory authorities, US FDA (510k no.: k060315) and its
technology granted with two US patents (Patent No. 6443906 and 6918879). A-PULSE
CASP is also clinical validated and approved by the regulatory authorities, US FDA (510k
no. : k072593).

Participants
A total of 2538 Asian subjects were studied. Subjects were drawn from Singapore and China
provinces (Beijing, Shanghai and Xi An) with the collaboration of Singapore and China
institutions. A medical questionnaire and written consent was obtained from the participants
before commencement of the test. Criteria were set to ensure that the data collected were to
correspond with the normotensive population. Thus 371 subjects were excluded from the
analysis for the responses stated below:
1. Irregular waveforms
2. Hypertension (brachial SBP > 140 mmHg / DBP < 90 mmHg)
3. Diabetes mellitus
4. Renal disease
5. Cardiovascular disease (defined as a clinical history or evidence on examination)

Furthermore, 10 subjects were also excluded due to incomplete hemodynamic readings and
biodata at the time of analysis. Finally there were a total of 1036 females and 1121 males and
they are divided into 7 age groups as shown in Table 1 below with the youngest age 11 and
the oldest age 90.

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 Male Female Total
Age range
N % N % N %
<20 179 8.3 99 4.6 278 12.9
21 – 30 268 12.4 236 10.9 504 23.4
31 – 40 181 8.4 162 7.5 343 15.9
41 – 50 196 9.1 251 11.6 447 20.7
51 – 60 174 8.1 179 8.3 353 16.4
61 – 70 73 3.4 72 3.3 145 6.7
>70 50 2.3 37 1.7 87 4.0
Total 1121 52.0 1036 48.0 2157 100.0
Table 1: Age Group Distribution

Brachial Blood Pressure

Blood pressure was recorded at the brachial site of the non-dominant arm (in-level with the
heart) using an oscillometric sphygmomanometer. Subjects were required to rest for 5
minutes before taking measurement. The brachial blood pressure was measured three times
with an interval of 1 minute and the average value was recorded for calibration.

Waveform Analysis

Figure 3: Cross section of BPro® secured to the wrist and BPro® connected with A-PULSE software

A BPro® blood pressure monitoring device, connected to a laptop with an A-PULSE CASP
software programme as shown in Figure 3 were used to capture real-time peripheral signals
by the technique of “Modified Applanation Tonometry”. The sensor plunger on the BPro®
device is positioned and strapped directly on top of the radial artery with adequate pressure.
All subjects are in sitting position with their arms resting on the table and bodies remaining
still while measuring. Pulse signals were recorded with 60Hz in blocks of 10 seconds using
the A-Pulse software programme. Each block of signal is ensemble-averaged to give the
averaged radial waveform for each subject. This waveform will be calibrated with the input
brachial blood pressures obtained from the sphygmomanometer. A patented formulation
incorporated in the software will then derive the various indices from the waveform obtained.

Data Analysis
Values of the various indices were selected from the first two blocks of the waveform
captured in the A-PULSE CASP software. A scatter plot graph with a regression linear curve
was drawn through least square method. In addition, a reference range of 95% individual
confidence interval (CI) was also obtained. Furthermore, regression analysis was performed

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for the correlation of the various indices and age. All analysis was performed with SPSS 13.0
software and Microsoft Office Excel 2003.

Results and Discussion

The demographic characteristic of the population are tabulated in Table 2. The mean height
and weight shows that the males were tentatively (11.7 ± 0.21 cm) taller and (9.8 ± 0.28 kg)
heavier as compared to females.

MEAN ± Standard Deviation

Parameters Male Female Total
N 1121 1036 2157
Height (cm) 171.5 ± 6.6 160.0 ± 6.9 166.0 ± 8.9
Weight (kg) 67.2 ± 11.3 57.5 ± 9.0 62.5 ± 11.3
SBP (mmHg) 120.0 ± 10.2 114.2 ± 12.1 117.2 ± 11.5
DBP (mmHg) 75.3 ± 8.0 73.5 ± 8.5 74.4 ± 8.3
PR (bpm) 79.5 ± 13.8 78.4 ± 10.9 79.0 ± 12.5
CASP (mmHg) 108.1 ± 9.8 106.5 ± 12.0 107.3 ± 10.9
SUG (mmHg/msec) 0.37 ± 0.10 0.30 ± 0.08 0.34 ± 0.10
Systolic Cycle (%) 39.7 ± 5.9 41.7 ± 5.0 40.7 ± 5.6
RNA 0.49 ± 0.14 0.52 ± 0.13 0.50 ± 0.14
Table 2: Demographic of Normal Asian Subjects

Distribution of the various indices for normotensive healthy subjects will be drawn across the
age using simple scatter plot with linear equation of the respective indices determined using
linear regression analysis. These distributions and linear equations will also be plotted for
male and female population respectively.

CASP
In the scatter plot below in Figure 4, the graph shows the distribution of CASP for
normotensive population across the age using simple scatter plot with a linear equation
determined using linear regression analysis. Linear regression equation of: Y = 0.30*X +
95.47 (red line) was determined with CASP as the dependent factor. A 95% CI was obtained
with the 5% lower CI equation: Y = 0.30*X + 74.04 (Lower black line) and the 5% upper CI:
Y = 0.30*X + 116.90 (Upper black line). As mentioned above, CASP is the maximum
pressure at the root of aorta (the largest artery in the body). It is different from and is usually
lower than brachial SBP in normal people. As shown in recent large epidemic clinical studies
(N = 10613), brachial SBP and pulse pressure had large differences with the aortic ones,
especially in young people [9]. And although the difference decreases with age, significant
differences in SBP (Mean ± SD, 11 ± 4 and 8 ± 3 mm Hg for men and women respectively)
could still be found in the older people aged above 80 years old. It has been proven that
CASP cannot be reliably inferred from brachial BP. It directly affects heart and coronary as
well as carotid arteries and is directly related to the incidence of major cardiovascular
complications. Assessment of CASP may improve the stratification and management of
patients with elevated cardiovascular risk. Hence, it has been regarded with greater
importance with more clinical studies and even inclusion of its measurement in the
determination of hypertension.

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 Y = 0.30*X + 95.47

Figure 4: Scatter Plot for CASP Total Population

Y = 0.30*X + 116.90

Y = 0.30*X + 95.47

Y = 0.30*X + 74.04

Figure 5: CASP Total Population at 95% CI

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With the scatter plots of 2157 data collected across the ages, linear regression line with 95%
confidence interval have been plotted as a reference range to represent the total population
for CASP measurement. This reference range serves as a guide for users to have an idea how
much their measurement may be away from the ideal (the plotted regression line) with
respect to their age as shown below in Figure 5.

Y = 0.20*X + 100.21

Figure 6: Scatter Plot for CASP Male Population

Similar male population scatter plot graph for CASP was also plotted across the age group in
Figure 6 shown below. Linear regression equation obtained for male gender population: Y =
0.20*X + 100.21 (Red line). And the reference range shown in Figure 7 with individual CI
was evaluated at 95% with for lower 5% CI: Y = 0.20*X + 80.93 (Lower black line) and the
upper 5% CI: Y = 0.20*X + 119.49 (Upper black line).

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 Y = 0.20*X + 119.49

Y = 0.20*X + 100.21

Y = 0.20*X + 80.93

Figure 7: SUG Male Population at 95% CI

Y = 0.43*X + 89.02

Figure 8: Scatter Plot for CASP Female Population

In Figure 8 above, a linear regression equation for CASP female gender population: Y =
0.43*X + 89.02 (Red Line). While in Figure 9 below shows the individual CI was evaluated
at 95% with the lower 5% CI: Y = 0.43*X + 65.59 (Lower black line) and the upper 5% CI:
Y = 0.43*X + 112.46 (Upper black line).

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 Y = 0.43*X + 112.46

Y = 0.43*X + 89.02

Y = 0.43*X + 65.59

Figure 9: CASP Female Population at 95% CI

CASP vs Age
140

N(Male) = 1121
N(Female) = 1036
130
N(Total) = 2157
y = 0.43x + 89.02
R2 = 0.31
120
CASP (mmHg)

110 y = 0.20x + 100.21

R2 = 0.12

100

90 Linear (Female )
Linear (Male)

80
0 10 20 30 40 50 60 70 80 90 100
Age (years)

Figure 10: CASP gender comparison for Male and Female Population

As stated in Table 2, the mean±SD for male CASP population of 108.1 ± 9.8 mmHg is
slightly higher than that of 106.5 ± 12.0 mmHg for females. However, only through Figure
10 above that shows the linear regression of CASP male and female population, the gradient
difference of the regression lines can be identified. The smaller value of 0.20 for CASP male

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regression line is less steep as compared to the gradient of 0.43 for CASP female population.
Also, from the interception point corresponding close to 50 years old, CASP value of male
less than this age is generally higher than that of female. And beyond 50 years old which
corresponds to the age of menopause for female, female CASP values are higher than that of
males. It is known that women have significantly lower morbidity and mortality from
ischemic heart disease than do men until after the age of menopause [8]. Given the effect of
age and gender on central arterial hemodynamic, CASP reference range plots according to
gender is a better reflection of one’s CASP measurement. It is especially important in
treatments such as anti-hypertensive drugs which substantially give rise to different effect on
CASP (which is a better indicator of cardiovascular diseases) despite a similar effect on
brachial BP. This study highlights the prevalence of gender difference in the use of reference
guides according to gender which attributes to better and more effective assessment of the
cardiac health.

SUG
Systolic upstroke gradient denotes the steep increase in arterial pressure corresponding to the
contraction of the heart as it ejects blood into the arterial system. Magnitude of this gradient
is dependent on the volume ejected and the distensibility of the arteries. Distensibility refers
to the capability of arteries to be distended or stretched. When arteries cannot dilate as much
as required, blood pressure increases which puts an added strain on the heart. Stiff arteries
impact the entire performance of your cardiovascular system. Hence, older people who have
less distensible arteries normally have higher systolic blood pressure than that of younger
subjects. This can be seen in the decrease of gradient as age increases in Figure 11 below.
SUG which is an index that denotes the distensibility of arteries is a very important
characteristic that is related to cardiovascular health.

Y = -0.0016*X + 0.40

Figure 11: Scatter Plot for SUG Total Population

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In Figure 12, the graph shows the distribution of SUG for normotensive people across the age
using simple scatter plot with a linear equation determined using linear regression analysis.
Linear regression equation of: Y = -0.0016*X + 0.40 (red line) was determined with SUG as
the dependent factor. A 95% CI was obtained with the 5% lower CI equation: Y = -0.0016*X
+ 0.21 (Lower black line) and the 5% upper CI: Y = -0.0016*X + 0.59 (Upper black line).

Y = -0.0016*X + 0.59

Y = -0.0016*X + 0.40

Y = -0.0016*X + 0.21

Figure 12: SUG Total Population at 95% CI

Y = -0.0022*X + 0.46

Figure 13: Scatter Plot for SUG Male Population

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Male population scatter plot graph shown above in Figure 13 was drawn for SUG across the
age group. Linear regression equation obtained for male gender population: Y = -0.0022*X
+ 0.46 (red line). Individual CI was evaluated at 95% with the lower 5% CI: Y = -0.0022*X
+ 0.26 (Lower black line) and the upper 5% CI: Y = -0.0022*X + 0.65 (Upper black line).

Y = -0.0022*X + 0.65

Y = -0.0022*X + 0.46

Y = -0.0022*X + 0.26

Figure 14: SUG Male Population at 95% CI

Y = -0.0006*X + 0.32
6

Figure 15: Scatter Plot for SUG Female Population

Linear regression equation for SUG female gender population: Y = -0.0006*X + 0.32 (red
Line). Individual CI was evaluated at 95% with the lower 5% CI: Y = -0.0006*X + 0.16

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(Lower red line) and the upper 5% CI: Y = -0.0006*X + 0.48 (Upper red line) shown in
Figure 16.

Y = -0.0006*X + 0.48
6
Y = -0.0006*X + 0.32
6
Y = -0.0006*X + 0.16
6

Figure 16: SUG Female Population at 95% CI

SUG vs Age
0.5

Linear (Male)
y = -0.0022x + 0.45
Linear (Female)
R2 = 0.14
SUG (mmHg/msec)

0.4

0.3
y = -0.0006x + 0.32
R2 = 0.014

0.2
0 10 20 30 40 50 60 70 80 90 100
Age (years)

Figure 17: SUG gender comparison for Male and Female Population

As stated in Table 2, the mean±SD for SUG male population of 0.37 ± 0.10 mmHg/msec is
slightly higher than that of 0.30 ± 0.08 mmHg/msec for females. And the gradient of the

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regression line for SUG male population of -0.0022 is steeper than that of SUG female
population of -0.0006 (Figure 17). This highlights the gender difference that there is a
gradual decrease in SUG for males as compared to that of females which yields a lower value
and an almost consistent value across the age group.

Systolic Cycle
Systolic cycle is the percentage of duration of systole over the entire duration of the cardiac
cycle. Systole is the period where left ventricle of the heart is contracting. Cardiac cycle
refers to all or any of the events related to the flow or blood pressure that occurs from the
beginning of one heartbeat to the beginning of the next [10]. Percentage of duration of
systole over the entire cardiac cycle denotes the ratio of period where the heart is not relaxing
over the entire period. As such, this percentage is better maintained at a lower percentage.
And from the tabulated data shown in table 2, the mean±SD for systolic cycle for the total
population collected is 40.7 ± 5.6 %.

Y = 0.073*X + 37.81

Figure 18: Scatter Plot for Systolic Cycle Total Population

The graph in Figure 18 shows the distribution of systolic cycle for normotensive people
across the age using simple scatter plot with a linear equation determined using linear
regression analysis. Linear regression equation of: Y = 0.073*X + 37.81 (red line) was
determined with systolic cycle as the dependent factor. A 95% CI was obtained with the 5%
lower CI equation: Y = 0.073*X + 26.80 (Lower black line) and the 5% upper CI: Y =
0.073*X + 48.81 (Upper black line).

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 Y = 0.073*X + 48.81

Y = 0.073*X + 37.81

Y = 0.073*X + 26.80

Figure 19: 95% CI for Systolic Cycle Total Population

Y = 0.10*X + 35.86

Figure 20: Scatter Plot for Systolic Cycle Male Population

Similar male population scatter plot graph for systolic cycle was also plotted across the age
group in Figure 20. Linear regression equation obtained for male gender population: Y =
0.10*X + 35.86 (red line). Individual CI was evaluated at 95% with the lower 5% CI: Y =

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0.10*X + 24.21 (Lower black line) and the upper 5% CI: Y = 0.10*X + 47.51 (Upper black
line) as shown in Figure 21.

Y = 0.10*X + 47.51

Y = 0.10*X + 35.86

Y = 0.10*X + 24.21

Figure 21: Systolic Cycle Male Population at 95% CI

Y = 0.03*X + 40.50

Figure 22: Scatter Plot for Systolic Cycle Female Population

In Figure 23 below, linear regression equation for systolic cycle female gender population: Y
= 0.03*X+ 40.50 (red Line). Individual CI was evaluated at 95% with the lower 5% CI: Y =
0.03*X+ 30.63 (Lower red line) and the upper 5% CI: Y = 0.03*X+ 50.37 (Upper red line).

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 Y = 0.03*X + 50.37

Y = 0.03*X + 40.50

Y = 0.03*X + 30.63

Figure 23: Systolic Cycle Female Population at 95% CI

Systolic cycle Vs Age

50

y = 0.030x + 40.50
R2 = 0.0088
Systolic Cycle (%)

40

y = 0.10x + 35.86
R2 = 0.081

Linear (Male)
Linear (Female)
30
0 10 20 30 40 50 60 70 80 90 100
Age (years)

Figure 24: Systolic cycle gender comparison for Male and Female Population

As tabulated in Table 2, the mean±SD for systolic cycle male population is 39.7 ± 5.9 % is
slightly lower than that of 41.7 ± 5.0 % for females. And the gradient of the regression line

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for systolic cycle male population of 0.10 is steeper than that of systolic cycle female
population of 0.030 (Figure 24). Gender difference is observed again that there is a gradual
increase in systolic cycle for males as compared to that of females which yields an almost
consistent value across the age group.

RNA
Ratio of net area as mentioned above refers to the net area of period in systole over net area
of period in diastole (Area A over Area B in Figure 2). The area under systolic curve (area A)
indicates the work done by the heart in this heart cycle. The larger the area A, the harder the
heart works. The area under diastolic curve (area B) indicates the blood perfusion potentiality
to coronary arteries as blood supply to heart happens mostly during diastolic period. Larger
area B gives rise to better perfusion to coronary arteries where blood is supplied to heart. It
has been tabulated from Table 2 that the RNA of the collected total population is generally a
mean±SD of 0.50 ± 0.14.

Y = 0.0005*X + 0.48

Figure 25: Scatter Plot for RNA Total Population

The graph in Figure 25 shows the distribution of RNA for normotensive people across the
age using simple scatter plot with a linear equation determined using linear regression
analysis. Linear regression equation of: Y = 0.0005*X + 0.48 (red line) was determined with
SUG as the dependent factor. A 95% CI was obtained with the 5% lower CI equation: Y =
0.0005*X + 0.21 (Lower black line) and the 5% upper CI: Y = 0.0005*X + 0.76 (Upper
black line) as shown in Figure 26.

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 Y = 0.0005*X + 0.76
Y = 0.0005*X + 0.48

Y = 0.0005*X + 0.21

Figure 26: 95% CI for RNA Total Population

Y = 0.0015*X + 0.43

Figure 27: Scatter Plot for RNA Male Population

Similar male population scatter plot graph in Figure 27 for RNA was also plotted across the
age group. Linear regression equation obtained for male gender population: Y = 0.0015*X +
0.43 (red line). Individual CI was evaluated at 95% with the lower 5% CI: Y = 0.0015*X +

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0.15 (Lower black line) and the upper 5% CI: Y = 0.0015*X + 0.70 (Upper black line) as
shown in Figure 28.

Y = 0.0015*X + 0.70

Y = 0.0015*X + 0.43
Y = 0.0015*X + 0.15

Figure 28: RNA Male Population at 95% CI

Y = -0.001*X + 0.57

Figure 29: Scatter Plot for RNA Female Population

In Figure 29, linear regression equation for RNA female gender population: Y = -0.001*X +
0.57 (red Line). Individual CI was evaluated at 95% with the lower 5% CI: Y = -0.001*X +

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0.30 (Lower red line) and the upper 5% CI: Y = -0.001*X + 0.83 (Upper red line) as shown
in Figure 30.

Y = -0.001*X + 0.83
Y = -0.001*X + 0.57

Y = -0.001*X + 0.30

Figure 30: RNA Female Population at 95% CI

RNA Vs Age
0.7

0.6 y = -0.001x + 0.57

R2 = 0.015
RNA

0.5

y = 0.0015x + 0.43
0.4 R2 = 0.034

Linear (Male)
Linear (Female)
0.3
0 10 20 30 40 50 60 70 80 90 100
Age (years)

Figure 31: RNA gender comparison for Male and Female Population

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As stated in Table 2, the mean±SD for RNA male population of 0.49 ± 0.14 is slightly lower
than that of 0.52 ± 0.13 for females. The gradient of the regression line for RNA male
population is 0.0015 while that of SUG female population is -0.001 (Figure 31). This can be
attributed by the gender difference as we notice a different phenomenon with an increasing
RNA of male population as compared to a decreasing RNA in the female population across
the age group.

Conclusion
With the long history of research and analysis in pulsewave analysis, clinical studies and
improvement in devices to measure pulse waveform have not ceased with the increasing
importance of such pulse waveforms. The ability to express these waveform indices in terms
of numbers not only aid in the determination of the effects of drugs and other interventions,
reference ranges and trends have been generated to monitor and aid in improving the quality
of our health. Through this study, we highlight other waveform indices such as CASP, SUG,
systolic cycle and RNA with brief analysis and their reference ranges. Currently, there has
been a shift to include CASP measurements and reference ranges in a few guidelines for
hypertension. Hence, it is hoped that more outcome studies and trials may be conducted to
seek greater relevance and correlations of these waveform indices to our health. Therefore in
future, we seek to attach weightage to these waveform indices to generate a composite index.
And with this impactful composite index comprising of all the important indices, we may
obtain a more accurate indicator of our cardiac health.

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Reference

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