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Twenty-four-hour central (aortic) systolic blood pressure: Reference values and dipping patterns in untreated individuals


Weber, T and Protogerou, AD and Agharazii, M and Argyris, A and Bahous, SA and Banegas, JR and Binder, RK and Blacher, J and Brandao, AA and Cruz, JJ and Danninger, K and Giannatasio, C and Graciani, A and Hametner, B and Jankowski, P and Li, Y and Maloberti, A and Mayer, CC and McDonnell, BJ and McEniery, CM and Gomes, MAM and Gomes, AM and Muiesan, ML and Nemcsik, J and Paini, A and Rodilla, E and Schutte, AE and Sfikakis, PP and Terentes-Printzios, D and Vallee, A and Vlachopoulos, C and Ware, L and Wilkinson, I and Zweiker, R and Sharman, JE and Wassertheurer, S, International Academic 24-Hour Ambulatory Aortic Blood Pressure Consortium (, Twenty-four-hour central (aortic) systolic blood pressure: Reference values and dipping patterns in untreated individuals, Hypertension ISSN 0194-911X (2021) [Refereed Article]

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Copyright Statement

2021 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, ( which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made

DOI: doi:10.1161/HYPERTENSIONAHA.121.17765


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.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, hypertension, public health, education, accuracy of blood pressure measurement
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Sharman, JE (Professor James Sharman)
ID Code:147311
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-10-25
Last Modified:2021-12-06
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