Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors


Annie Herbert, University Paris Descartes
John Kennedy Cruickshank, King's College London
Stephane Laurent, University Paris Descartes, Hospital European Georges-Pompidou
Pierre Boutouyrie, Hospital European Georges-Pompidou, Paris Descartes University
Kazuyuki Shimada, Jichi Medical University
Kazuomi Kario, Jichi Medical University
Hiroshi Miyashita, Jichi Medical University
Kazuo Eguchi, Jichi Medical University
Katsuhiko Kohara, Ehime University
Yasuharu Tabara, Kyoto University
Yutaka Imai, Tohoku University
Sadayoshi Ito, Tohoku University
Junichiro Hashimoto, Tohoku University
Kiyoshi Uchiba, Ohoka Clinic
Hiromichi Suzuki, Saitama University
Tsuneo Takenaka, Saitama University
Kenji Takazawa, Tokyo Medical University
Mineko Kino, Tokyo Medical University
Akira Yamashina, Tokyo Medical University
Hirofumi Tomiyama, Tokyo Medical University
Yasuaki Dohi, Nagoya University
Hiroyuki Takase, Enshu Hospital
Xavier Jouven, University Paris Descartes
Jean Empana, University Paris Descartes
Bruno Pannier, University Paris Descartes, Hospital European Georges-Pompidou
Frederique Thomas, University Paris Descartes
Eva Prescott, University of Copenhagen
Julie Janner, University of Copenhagen
Carmel McEniery, University of Cambridge
John Cockcroft, Cardiff Metropolitan University
Ian Wilkinson, University of Cambridge
Mary Roman, Weill Cornell Medicine
Richard Devereux, Weill Cornell Medical College
Valerie Teal, University of Pennsylvania
Raymond Townsend, University of Pennsylvania
Sebastian Vermeersch, Ghent University, Belgium
Ernst Rietzschel, Ghent University Hospital
Luc Van Bortel, Ghent University, Belgium
Marc De Buyzere, Ghent University Hospital
Patrick Segers, Ghent University, Belgium
Thierry Gillebert, Ghent University Hospital
Ji-Guang Wang, Shanghai Jiao Tong University
Yan Li, Shanghai Jiao Tong University
Jason Lazar, SUNY Downstate Medical Center
Louis Salciccioli, SUNY Downstate Medical Center
Pedro Cunha, University of Minho
Pedro Oliveira, Oporto University
Jorge Cotter, University of Minho
Isabel Vila, University of Minho
Nuno Sousa, University of Minho
Julio Chirinos, University of Pennsylvania
Josefina Medina-Lezama, Santa Maria Catholic University
Thomas Weber, Klinikum Wels-Grieskirchen, Standort Wels
Martin Rammer, Klinikum Wels-Grieskirchen, Standort Wels
M F. O'Rourke, University of New South Wales
Eber Bernd, Klinikum Wels-Grieskirchen, Standort Wels
Elisabeth Lassnig, Klinikum Wels-Grieskirchen, Standort Wels
Michael Porodko, Klinikum Wels-Grieskirchen, Standort Wels
Marcus Ammer, Klinikum Wels-Grieskirchen, Standort Wels
Siegfried Wassertheurer, Austrian Institute of Technology
Audrey Adji, Macquarie University
Stefan Rosenkranz, Austrian Institute of Technology
Christian Punzengruber, Klinikum Wels-Grieskirchen, Standort Wels
Erich Kvas, Hermesoft Biostatistics
Carole Dufouil, Universite Pierre et Marie Curie
Christophe Tzourio, Universite Pierre et Marie Curie
Giel Nijpels, VU University Medical Center
Jacqueline Dekker, VU University Medical Center
Coen D. Stehouwer, Maastricht University Medical Centre, Vu University Medical Centre
Isabel Ferreira, University of WollongongFollow
Jos Twisk, VU University Medical Center
Yvo Smulders, Vu University Medical Centre
Roel J. Van De Laar, Maastricht University Medical Centre
Carla J. H Van Der Kallen, Maastricht University Medical Centre
Marleen M. J Van Greevenbroek, Maastricht University Medical Centre
Casper Schalkwijk, Maastricht University Medical Centre
Charalambos Vlachopoulos, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
Constantinos Aznaouridis, University of Athens, Hippokration Hospital, Greece
Dimitrios Terentes-Printzios, Hippokration Hospital, Greece
Panos Xaplanteris, Hippokration Hospital, Greece
Christodoulos Stefanadis, University of Athens, Hippokration Hospital, Greece



Publication Details

Herbert, A., Cruickshank, J., Laurent, S., Boutouyrie, P., Shimada, K., Kario, K., Miyashita, H., Eguchi, K., Kohara, K., Tabara, Y., Imai, Y., Ito, S., Hashimoto, J., Uchiba, K., Suzuki, H., Takenaka, T., Takazawa, K., Kino, M., Yamashina, A., Tomiyama, H., Dohi, Y., Takase, H., Jouven, X., Empana, J., Pannier, B., Thomas, F., Prescott, E., Janner, J., McEniery, C., Cockcroft, J., Wilkinson, I., Roman, M., Devereux, R., Teal, V., Townsend, R., Vermeersch, S., Rietzschel, E., Van Bortel, L., De Buyzere, M., Segers, P., Gillebert, T., Wang, J., Li, Y., Lazar, J., Salciccioli, L., Cunha, P., Oliveira, P., Cotter, J., Vila, I., Sousa, N., Chirinos, J., Medina-Lezama, J., Weber, T., Rammer, M., O'Rourke, M., Bernd, E., Lassnig, E., Porodko, M., Ammer, M., Wassertheurer, S., Adji, A., Rosenkranz, S., Punzengruber, C., Kvas, E., Dufouil, C., Tzourio, C., Nijpels, G., Dekker, J., Stehouwer, C., Ferreira, I., Twisk, J., Smulders, Y., Van De Laar, R., Van Der Kallen, C., Van Greevenbroek, M., Schalkwijk, C., Vlachopoulos, C., Aznaouridis, C., Terentes-Printzios, D., Xaplanteris, P. & Stefanadis, C. (2014). Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. European Heart Journal, 35 (44), 3122-3133.


Aims: Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different available methods of measurement. How these values were significantly altered by cardiovascular risk factors (CVRFs) was then investigated. Methods and results: Existing data from population surveys and clinical trials were combined, whether published or not. Reference values of cSBP and amplification were calculatedas percentiles for 'Normal' (no CVRFs) and 'Reference' (any CVRFs) populations. We included 45 436 subjects out of 82 930 that were gathered from 77 studies of 53 centres. Included subjects were apparently healthy, not treated for hypertension or dyslipidaemia, and free from overt CV disease and diabetes. Values of cSBP and amplification were stratified by brachial blood pressure categories and age decade in turn, both being stratifiedbysex. Amplification decreased with age and more so in males than in females. Sex was the most powerful factor associated with amplification with 6.6 mmHg (5.8-7.4) higher amplification in males than in females. Amplification was marginally but significantly influenced by CVRFs, with smoking and dyslipidaemia decreasing amplification, but increased with increasing levels of blood glucose. Conclusion: Typical values of cSBP and amplification in a healthy population and a population free of traditional CVRFs are now available according to age, sex, and brachial BP, providing values included from different devices with a wide geographical representation. Amplification is significantly influenced by CVRFs, but differently in men and women.

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