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

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 calculated as 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 stratified by sex. 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.

[1]  J. Cockcroft,et al.  Isolated systolic hypertension in the young: a need for clarity. , 2013, Journal of hypertension.

[2]  Stéphane Laurent,et al.  Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. , 2013, European heart journal.

[3]  M. O'Rourke,et al.  Guidelines on guidelines: focus on isolated systolic hypertension in youth. , 2013, Journal of hypertension.

[4]  J. Blacher,et al.  Isolated systolic hypertension: ‘to treat or not to treat’ and the role of central haemodynamics , 2013, Journal of hypertension.

[5]  J. Carter,et al.  Sex differences in sympathetic neural and limb vascular reactivity to mental stress in humans. , 2013, American journal of physiology. Heart and circulatory physiology.

[6]  R. Kronmal,et al.  Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). , 2012, Journal of the American College of Cardiology.

[7]  M. O'Rourke,et al.  Brachial artery tonometry and the Popeye phenomenon: explanation of anomalies in generating central from upper limb pressure waveforms , 2012, Journal of hypertension.

[8]  Alberto Avolio,et al.  Estimation of central aortic systolic pressure using late systolic inflection of radial artery pulse and its application to vasodilator therapy , 2012, Journal of hypertension.

[9]  Hiroshi Miyashita,et al.  Clinical Assessment of Central Blood Pressure , 2012, Current hypertension reviews.

[10]  Siegfried Wassertheurer,et al.  Validation of a Brachial Cuff-Based Method for Estimating Central Systolic Blood Pressure , 2011, Hypertension.

[11]  Qi Zhang,et al.  Validation of the noninvasive assessment of central blood pressure by the SphygmoCor and Omron devices against the invasive catheter measurement. , 2011, American journal of hypertension.

[12]  A. Stanton,et al.  Pharmacological Modulation of Arterial Stiffness , 2011, Drugs.

[13]  J. Finn,et al.  Calibration mode influences central blood pressure differences between SphygmoCor and two newer devices, the Arteriograph and Omron HEM-9000 , 2011, Hypertension Research.

[14]  M. Taskinen,et al.  ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). , 2011, Atherosclerosis.

[15]  A. Schutte,et al.  Comparison of central pressure estimates obtained from SphygmoCor, Omron HEM-9000AI and carotid applanation tonometry , 2011, Journal of hypertension.

[16]  Yasmin,et al.  The Impact of Cardiovascular Risk Factors on Aortic Stiffness and Wave Reflections Depends on Age: The Anglo-Cardiff Collaborative Trial (ACCT III) , 2010, Hypertension.

[17]  Christodoulos Stefanadis,et al.  Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. , 2010, European heart journal.

[18]  Jamil Mayet,et al.  Wave reflection predicts cardiovascular events in hypertensive individuals independent of blood pressure and other cardiovascular risk factors: an ASCOT (Anglo-Scandinavian Cardiac Outcome Trial) substudy. , 2010, Journal of the American College of Cardiology.

[19]  Yasmin,et al.  Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’ , 2010, European heart journal.

[20]  J. Vestbo,et al.  Aortic augmentation index: reference values in a large unselected population by means of the SphygmoCor device. , 2010, American journal of hypertension.

[21]  Richard B Devereux,et al.  Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry: the Strong Heart Study , 2010, Journal of hypertension.

[22]  Joseph Cheriyan,et al.  The accuracy of central SBP determined from the second systolic peak of the peripheral pressure waveform , 2009, Journal of hypertension.

[23]  Pascal Verdonck,et al.  Amplification of the Pressure Pulse in the Upper Limb in Healthy, Middle-Aged Men and Women , 2009, Hypertension.

[24]  Patrick Segers,et al.  Role of pulse pressure amplification in arterial hypertension: experts' opinion and review of the data. , 2009, Hypertension.

[25]  K. Larkin,et al.  Cardiovascular Response to Interpersonal Provocation and Mental Arithmetic among High and Low Hostile Young Adult Males , 2009, Applied psychophysiology and biofeedback.

[26]  I. Wilkinson,et al.  Comparison of estimates of central systolic blood pressure and peripheral augmentation index obtained from the Omron HEM-9000AI and SphygmoCor systems , 2009 .

[27]  Yasmin,et al.  Central Pressure: Variability and Impact of Cardiovascular Risk Factors: The Anglo-Cardiff Collaborative Trial II , 2008, Hypertension.

[28]  Renata Cifkova,et al.  Erratum: Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and of the European Society of Cardiology (Journal of Hypertension (2007) 25, (1105-1187)) , 2007 .

[29]  Richard B. Devereux,et al.  Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The Strong Heart Study , 2007, Hypertension.

[30]  A. Dominiczak,et al.  2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) , 2007, European heart journal.

[31]  Kenji Takazawa,et al.  Relationship between Radial and Central Arterial Pulse Wave and Evaluation of Central Aortic Pressure Using the Radial Arterial Pulse Wave , 2007, Hypertension Research.

[32]  A. Dominiczak,et al.  2007 ESH‐ESC Guidelines for the management of arterial hypertension , 2007 .

[33]  Jan A Staessen,et al.  Reference Values in White Europeans for the Arterial Pulse Wave Recorded by Means of the SphygmoCor Device , 2006, Hypertension Research.

[34]  Alice Stanton,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006, Circulation.

[35]  S. Laurent,et al.  Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease. , 2006, Kidney international.

[36]  Thomas Weber,et al.  Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. , 2005, European heart journal.

[37]  Morris J. Brown,et al.  Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults , 2005, Hypertension.

[38]  Paolo Salvi,et al.  Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device , 2004, Journal of hypertension.

[39]  M. O'Rourke,et al.  The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients. , 2004, British journal of anaesthesia.

[40]  T. Laitinen,et al.  Effects of euglycaemic and hypoglycaemic hyperinsulinaemia on sympathetic and parasympathetic regulation of haemodynamics in healthy subjects. , 2003, Clinical science.

[41]  M. Safar,et al.  Clinical Utility of Aortic Pulses and Pressures Calculated From Applanated Radial-Artery Pulses , 2003, Hypertension.

[42]  Jaspal Kooner,et al.  Estimation of central aortic pressure by SphygmoCor requires intra-arterial peripheral pressures. , 2003, Clinical science.

[43]  J. Blacher,et al.  Central Pulse Pressure and Mortality in End-Stage Renal Disease , 2002, Hypertension.

[44]  G. London,et al.  Different Aortic Reflection Wave Responses Following Long‐Term Angiotensin‐Converting Enzyme Inhibition And Beta‐Blocker In Essential Hypertension , 2001, Clinical and experimental pharmacology & physiology.

[45]  M. O'Rourke,et al.  Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform , 2001, Hypertension.

[46]  M E Safar,et al.  Improvement in Blood Pressure, Arterial Stiffness and Wave Reflections With a Very-Low-Dose Perindopril/Indapamide Combination in Hypertensive Patient: A Comparison With Atenolol , 2001, Hypertension.

[47]  J. Staessen,et al.  Non-invasive assessment of local arterial pulse pressure: comparison of applanation tonometry and echo-tracking , 2001, Journal of hypertension.

[48]  S S Franklin,et al.  Predominance of Isolated Systolic Hypertension Among Middle-Aged and Elderly US Hypertensives: Analysis Based on National Health and Nutrition Examination Survey (NHANES) III , 2001, Hypertension.

[49]  C. Vlachopoulos,et al.  Spurious systolic hypertension in youth , 2000, Vascular medicine.

[50]  PierreBoutouyrie,et al.  Association Between Local Pulse Pressure, Mean Blood Pressure, and Large-Artery Remodeling , 1999 .

[51]  E. O’Brien,et al.  An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. , 1993, Journal of hypertension.

[52]  N. Kon,et al.  Does radial artery pressure accurately reflect aortic pressure? , 1992, Chest.

[53]  M. Edelman,et al.  Clinical manifestations of essential thrombocythemia in young adults , 1990, American journal of hematology.

[54]  J. Kennedy,et al.  BLOOD FLOW IN ARTERIES (2nd ed) , 1975 .

[55]  D. A. Mcdonald.  Blood flow in arteries , 1974 .

[56]  K. Takazawa,et al.  Correlation between the brachial blood pressure values obtained using the cuff method and the central blood pressure values obtained invasively. , 2013, Internal medicine.

[57]  Cm Nieuwegein.  How to assess mean blood pressure properly at the brachial artery level , 2007 .

[58]  Michael F. O'Rourke,et al.  Arterial vasodilation : mechanisms and therapy , 1993 .