Twenty-Four–Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals

Supplemental Digital Content is available in the text. Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

[1]  Mark Butlin,et al.  Are Korotkoff Sounds Reliable Markers for Accurate Estimation of Systolic and Diastolic Pressure Using Brachial Cuff Sphygmomanometry? , 2021, IEEE Transactions on Biomedical Engineering.

[2]  F. Madoré,et al.  Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure , 2020, Hypertension.

[3]  M. Böhm,et al.  Accuracy of pulse rate derived from 24-h ambulatory blood pressure monitoring compared with heart rate from 24-h Holter-ECG. , 2020, Journal of hypertension.

[4]  N. Babel,et al.  The impact of calibration approaches on the accuracy of oscillometric central aortic blood pressure measurement , 2020, Journal of hypertension.

[5]  J. Staessen,et al.  Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components , 2020, Hypertension.

[6]  A. Brandão,et al.  Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil‐O‐Graph PWA monitor , 2020, Hypertension Research.

[7]  N. Babel,et al.  Accuracy of fully automated oscillometric central aortic blood pressure measurement techniques. , 2020, Journal of hypertension.

[8]  R. Asmar,et al.  Feasibility of 24-h central blood pressure monitoring: experience from multinational clinical trial assessing the efficacy of perindopril/indapamide/amlodipine. , 2019, Journal of hypertension.

[9]  E. O’Brien,et al.  Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes. , 2019, JAMA.

[10]  G. Parati,et al.  Ambulatory blood pressure and arterial stiffness web‐based telemonitoring in patients at cardiovascular risk. First results of the VASOTENS (Vascular health ASsessment Of The hypertENSive patients) Registry , 2019, Journal of clinical hypertension.

[11]  E. C. Fischer,et al.  Central Blood Pressure Waves Assessment: A Validation Study of Non-invasive Aortic Pressure Measurement in Human Beings , 2019, 2019 Global Medical Engineering Physics Exchanges/ Pan American Health Care Exchanges (GMEPE/PAHCE).

[12]  J. Sharman,et al.  Intra-arterial analysis of the best calibration methods to estimate aortic blood pressure , 2019, Journal of hypertension.

[13]  Thomas Kahan,et al.  [2018 ESC/ESH Guidelines for the management of arterial hypertension]. , 2019, Kardiologia polska.

[14]  G. Lip,et al.  2018 ESC/ESH Guidelines for the management of arterial hypertension. , 2018, European heart journal.

[15]  K. Kario,et al.  High central blood pressure is associated with incident cardiovascular events in treated hypertensives: the ABC-J II Study , 2018, Hypertension Research.

[16]  J. Sharman,et al.  Aortic systolic pressure derived with different calibration methods: associations to brachial systolic pressure in the general population , 2018, Blood pressure monitoring.

[17]  K. Kario,et al.  Evaluation of Central Blood Pressure in an Asian Population: Comparison between Brachial Oscillometry and Radial Tonometry Methods , 2018, Pulse.

[18]  Philip J. Millar,et al.  Comparison of laboratory and ambulatory measures of central blood pressure and pulse wave reflection: hitting the target or missing the mark? , 2018, Journal of the American Society of Hypertension : JASH.

[19]  J. Blacher,et al.  Mechanisms of pulse pressure amplification dipping pattern during sleep time: the SAFAR study. , 2017, Journal of the American Society of Hypertension : JASH.

[20]  C. Giannattasio,et al.  Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study , 2017, HYPERTENSION.

[21]  A. Cremer,et al.  Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses. , 2017, Journal of the American College of Cardiology.

[22]  M. Smolensky,et al.  Circadian mechanisms of 24-hour blood pressure regulation and patterning. , 2017, Sleep medicine reviews.

[23]  Yoshio Kobayashi,et al.  Comparison of invasive and brachial cuff-based noninvasive measurements for the assessment of blood pressure amplification , 2017, Hypertension Research.

[24]  A. Hughes,et al.  Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization , 2017, European heart journal.

[25]  Yoshio Kobayashi,et al.  Crucial Effect of Calibration Methods on the Association Between Central Pulsatile Indices and Coronary Atherosclerosis , 2017, American journal of hypertension.

[26]  Department of Preventive Medicine and Public Health , 2017 .

[27]  J. Sharman,et al.  Importance of Calibration Method in Central Blood Pressure for Cardiac Structural Abnormalities. , 2016, American journal of hypertension.

[28]  Siegfried Wassertheurer,et al.  Accuracy of commercial devices and methods for noninvasive estimation of aortic systolic blood pressure a systematic review and meta-analysis of invasive validation studies , 2016, Journal of hypertension.

[29]  A. Protogerou,et al.  A comparison study of brachial blood pressure recorded with Spacelabs 90217A and Mobil-O-Graph NG devices under static and ambulatory conditions , 2016, Journal of Human Hypertension.

[30]  G. Stergiou,et al.  Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis , 2016, Hypertension.

[31]  Siegfried Wassertheurer,et al.  Assessment of systolic aortic pressure and its association to all cause mortality critically depends on waveform calibration , 2015, Journal of hypertension.

[32]  G. Mitchell,et al.  Central pressure should not be used in clinical practice. , 2014, Artery research.

[33]  S. Laurent,et al.  Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. , 2014, European heart journal.

[34]  J. Blacher,et al.  Association of left ventricular diastolic dysfunction with 24-h aortic ambulatory blood pressure: the SAFAR study , 2014, Journal of Human Hypertension.

[35]  J. Blacher,et al.  Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients: the SAFAR study , 2014, Journal of hypertension.

[36]  J. Cockcroft,et al.  Central blood pressure: current evidence and clinical importance. , 2014, European heart journal.

[37]  Geoffrey A Head,et al.  European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. , 2014, Journal of hypertension.

[38]  W. Abhayaratna,et al.  Randomized Trial of Guiding Hypertension Management Using Central Aortic Blood Pressure Compared With Best-Practice Care: Principal Findings of the BP GUIDE Study , 2013, Hypertension.

[39]  E. Lakatta,et al.  Hypertension Derivation and Validation of Diagnostic Thresholds for Central Blood Pressure Measurements Based on Long-Term Cardiovascular Risks , 2022 .

[40]  B. Williams,et al.  Novel Description of the 24-Hour Circadian Rhythms of Brachial Versus Central Aortic Blood Pressure and the Impact of Blood Pressure Treatment in a Randomized Controlled Clinical Trial: The Ambulatory Central Aortic Pressure (AmCAP) Study , 2013, Hypertension.

[41]  K. Kawecka-Jaszcz,et al.  Twenty-four-hour profile of central blood pressure and central-to-peripheral systolic pressure amplification. , 2013, American journal of hypertension.

[42]  Petros Sfikakis,et al.  Feasibility and reproducibility of noninvasive 24-h ambulatory aortic blood pressure monitoring with a brachial cuff-based oscillometric device. , 2012, American journal of hypertension.

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

[44]  B. Imholz,et al.  Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria , 2010, Blood pressure monitoring.

[45]  Stéphane Laurent,et al.  Amlodipine-Valsartan Combination Decreases Central Systolic Blood Pressure More Effectively Than the Amlodipine-Atenolol Combination: The EXPLOR Study , 2010, Hypertension.

[46]  J. Cockcroft,et al.  Central blood pressure estimation for the masses moves a step closer , 2010, Journal of Human Hypertension.

[47]  Geoffrey A Head,et al.  Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study , 2010, BMJ : British Medical Journal.

[48]  T. Weber,et al.  A new oscillometric method for pulse wave analysis: comparison with a common tonometric method , 2010, Journal of Human Hypertension.

[49]  K. Kario,et al.  Differential Effects Between a Calcium Channel Blocker and a Diuretic When Used in Combination With Angiotensin II Receptor Blocker on Central Aortic Pressure in Hypertensive Patients , 2009, Hypertension.

[50]  Bryan Williams,et al.  Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function Evaluation) study: CAFE-Heart Rate. , 2009, Journal of the American College of Cardiology.

[51]  Hao-Min Cheng,et al.  Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? , 2009, Journal of hypertension.

[52]  C. Vlachopoulos,et al.  The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: Evidence for specific class-effects of antihypertensive drugs on pressure amplification. , 2009, Current pharmaceutical design.

[53]  Riccardo Pini,et al.  Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study. , 2008, Journal of the American College of Cardiology.

[54]  M. Safar,et al.  A preliminary evaluation of the mean arterial pressure as measured by cuff oscillometry. , 2008, American journal of hypertension.

[55]  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.

[56]  G. Mancia,et al.  Central blood pressure measurements and antihypertensive therapy: a consensus document. , 2007, Hypertension.

[57]  R. Schmieder,et al.  Guidelines for management of arterial hypertension , 2007 .

[58]  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.

[59]  Yutaka Imai,et al.  Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. , 2005, Journal of hypertension.

[60]  R. Blantz,et al.  Blood pressure and cardiovascular risks: implications of the presence or absence of a nocturnal dip in blood pressure. , 2003, Current opinion in nephrology and hypertension.

[61]  G. V. van Montfrans,et al.  Twenty-four-hour non-invasive monitoring of systemic haemodynamics and cerebral blood flow velocity in healthy humans. , 2002, Acta physiologica Scandinavica.

[62]  G. V. van Montfrans,et al.  Circadian rhythms in systemic hemodynamics and renal function in healthy subjects and patients with nephrotic syndrome. , 2001, Kidney international.

[63]  L. Poston,et al.  A validation of the Mobil O Graph (version 12) ambulatory blood pressure monitor , 2000, Blood pressure monitoring.

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

[65]  J. Kastrup,et al.  Nocturnal variations in peripheral blood flow, systemic blood pressure, and heart rate in humans. , 1991, The American journal of physiology.

[66]  J. Laragh,et al.  Blood pressure during normal daily activities, sleep, and exercise. Comparison of values in normal and hypertensive subjects. , 1982, JAMA.

[67]  A. J. Honour,et al.  Continuous recording of direct arterial pressure in unrestricted patients. Its role in the diagnosis and management of high blood pressure. , 1975, Circulation.