title: Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France Research & Development Department, Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Herbert
authors.affiliation: Diabetes, Cardiovascular Medicine & Nutrition, King's College University of London & King's Health Partners, London, UK pierre.boutouyrie@egp.aphp.fr kennedy.cruickshank@kcl.ac.uk.
authors.forename: John Kennedy
authors.initials: JK
authors.lastname: Cruickshank
authors.affiliation: Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
authors.affiliation: Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France pierre.boutouyrie@egp.aphp.fr kennedy.cruickshank@kcl.ac.uk.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D017678:Sex Distribution; D013599:Systole / Q000502:physiology; D055815:Young Adult
keywords: Adult; Aged; Aorta; Arteries; Arteriosclerosis; Blood pressure; Central pressure; Humans; Pulse