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

Annie Herbert, John Kennedy Cruickshank, Stephane Laurent, The Reference Values for Arterial Measurements Collaboration, Coen Stehouwer, I. Ferreira, Casper Schalkwijk, Marleen van Greevenbroek, Carla van der Kallen, Rafli van de Laar, Jan Staessen, Pierre Boutouyrie*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.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.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.Published on behalf of the European Society of Cardiology. All rights reserved. ? The Author 2014. For permissions please email:
Original languageEnglish
Pages (from-to)3122–3133
JournalEuropean Heart Journal
Issue number44
Publication statusPublished - 21 Nov 2014


  • Adult
  • Aged
  • Aorta
  • Arteries
  • Arteriosclerosis
  • Blood pressure
  • Central pressure
  • Humans
  • Pulse

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