Skip to main content
Log in

Impact of Methodological and Calibration Approach on the Association of Central and Peripheral Systolic Blood Pressure with Cardiac Structure and Function in Children, Adolescents and Adults

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript



Peripheral and aortic systolic blood pressure (pSBP and aoSBP) were measured using different methodological and calibration approaches to analyze the association and agreement between pSBP and/or aoSBP, and the association of pSBP and aoSBP with left ventricle (LV) and atrium (LA) structural–functional characteristics.


In healthy subjects (n = 269, age: 9–85 years; n = 147, age < 24 years) LV and LA parameters were echocardiography-derived. pSBP and aoSBP were obtained by brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), using three calibration schemes: systo-diastolic (SD), calculated mean (CM), and oscillometric mean (OscM).


Always pSBP and aoSBP were positively associated; aoSBP obtained with the Mobil-O-Graph® and calibrated to CM or OscM were the ones that showed the lowest levels of association with the remaining forms of aoSBP and pSBP. Bland-Altman related mean errors varied noticeably (e.g. − 27, − 23, − 17, − 12 or 8 mmHg when aoSBP obtained with MOG (OscM) was compared with data from other methodological and calibration schemes). The aoSBP data obtained with Mobil-O-Graph® (calibration: CM and OscM) showed the highest levels of association with cardiac structural characteristics. aoSBP values obtained calibrating to OscM were higher than those obtained calibrating to SD or CM.


aoSBP obtained with Mobil-O-Graph® and calibrated to CM or OscM showed (1) lower association with other forms of aoSBP and pSBP determination and (2) higher levels of association with LV and LA structural characteristics. Differences in aoSBP data between approaches were more sensitive to the calibration method than to the device used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Papaioannou TG, Karageorgopoulou TD, Sergentanis TN, Protogerou AD, Psaltopoulou T, Sharman JE, Weber T, 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. J Hypertens. 2016;34(7):1237–48.

    Article  CAS  Google Scholar 

  2. Hope SA, Meredith IT, Cameron JD. Effect of non-invasive calibration of radial waveforms on error in transfer-function-derived central aortic waveform characteristics. Clin Sci (Lond). 2004;107:205–11.

    Article  Google Scholar 

  3. Papaioannou TG, Lekakis JP, Karatzis EN, Papamichael CM, Stamatelopoulos KS, Protogerou AD, Mavrikakis M, et al. Transmission of calibration errors (input) by generalized transfer functions to the aortic pressures (output) at different hemodynamic states. Int J Cardiol. 2006;110:46–52.

    Article  Google Scholar 

  4. Nakagomi A, Okada S, Shoji T, Kobayashi Y. Crucial effect of calibration methods on the association between central pulsatile indices and coronary atherosclerosis. Am J Hypertens. 2017;30:24–7.

    Article  Google Scholar 

  5. Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC, Kropf J, et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension. 2011;58(5):825–32.

    Article  CAS  Google Scholar 

  6. Wassertheurer S, Hametner B, Mayer CC, Hafez A, Negishi K, Papaioannou TG, Protogerou AD, et al. Aortic systolic pressure derived with different calibration methods: associations to brachial systolic pressure in the general population. Blood Press Monit. 2018;23(3):134–40.

    PubMed  Google Scholar 

  7. Negishi K, Yang H, Wang Y, Nolan MT, Negishi T, Pathan F, Marwick TH, et al. Importance of calibration method in central blood pressure for cardiac structural abnormalities. Am J Hypertens. 2016;29(9):1070–6.

    Article  Google Scholar 

  8. Agnoletti D, Zhang Y, Salvi P, Borghi C, Topouchian J, Safar ME, Blacher J. Pulse pressure amplification, pressure waveform calibration and clinical applications. Atherosclerosis. 2012;224(1):108–12.

    Article  CAS  Google Scholar 

  9. Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016;67(1):183–90.

    Article  CAS  Google Scholar 

  10. Mitchell GF. Does measurement of central blood pressure have treatment consequences in the clinical praxis? Curr Hypertens Rep. 2015;17(8):66.

    Article  Google Scholar 

  11. Protogerou AD, Argyris AA, Papaioannou TG, Kollias GE, Konstantonis GD, Nasothimiou E, Achimastos A, et al. Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients: the SAFAR study. J Hypertens. 2014;32:1805–14.

    Article  CAS  Google Scholar 

  12. Wassertheurer S, Baumann M. Assessment of systolic aortic pressure and its association to all-cause mortality critically depends on waveform calibration. J Hypertens. 2015;33:1884–8.

    Article  CAS  Google Scholar 

  13. Diaz A, Zócalo Y, Bia D. Reference intervals and percentile curves of echocardiographic left ventricular mass, relative wall thickness and ejection fraction in healthy children and adolescents. Pediatr Cardiol. 2018;40(2):283–301.

    Article  Google Scholar 

  14. Díaz A, Zócalo Y, Bia D, Sabino F, Rodríguez V, Cabrera FIscher EI. Reference intervals of aortic pulse wave velocity assessed with an oscillometric device in healthy children and adolescents from Argentina. Clin Exp Hypertens. 2019;41(2):101–12.

    Article  Google Scholar 

  15. Díaz A, Zócalo Y. Bia D Normal percentile curves for left atrial size in healthy children and adolescents. Echocardiography. 2019;36(4):770–82.

    Article  Google Scholar 

  16. WHO global recommendations on physical activity for health. World Health Organization. 2010. Accessed 1 Sept 2019.

  17. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, Invitti C, et al. European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887–920.

    Article  CAS  Google Scholar 

  18. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, De Palma SM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):e13–115.

    CAS  PubMed  Google Scholar 

  19. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, et al. European network for non-invasive investigation of large arteries Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

    Article  Google Scholar 

  20. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am SocEchocardiogr. 2010;23(5):465–95.

    Article  Google Scholar 

  21. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.

    Article  Google Scholar 

  22. Sharman JE, Avolio AP, Baulmann J, Benetos A, Blacher J, Blizzard CL, Boutouyrie P, et al. Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization. Eur Heart J. 2017;38(37):2805–12.

    Article  Google Scholar 

  23. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.

    Article  CAS  Google Scholar 

  24. Weiss W, Gohlisch C, Harsch-Gladisch C, Tölle M, Zidek W, van der Giet M. Oscillometric estimation of central blood pressure: validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Press Monit. 2012;17(3):128–31.

    Article  Google Scholar 

  25. Horvath IG, Nemeth A, Lenkey Z, Alessandri N, Tufano F, Kis P, Gazner B, et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J Hypertens. 2010;28(10):2068–75.

    Article  CAS  Google Scholar 

  26. Zahnd G, Kapellas K, van Hattem M, van Dijk A, Sérusclat A, Moulin P, van der Lugt A, et al. A fully-automatic method to segment the carotid artery layers in ultrasound imaging—application to quantify the compression-decompression pattern of the intima-media complex during the cardiac cycle. Ultrasound Med Biol. 2017;43(1):239–57.

    Article  Google Scholar 

  27. Vermeersch SJ, Rietzschel ER, De Buyzere ML, De Bacquer D, De Backer G, Van Bortel LM, Gillebert TC, et al. Determining carotid artery pressure from scaled diameter waveforms: comparison and validation of calibration techniques in 2026 subjects. Physiol Meas. 2008;29(11):1267–80.

    Article  CAS  Google Scholar 

  28. Zócalo Y, Bia D, Armentano RL, González-Moreno J, Varela G, Calleriza F, Reyes-Caorsi W. Resynchronization improves heart-arterial coupling reducing arterial load determinants. Europace. 2013;15(4):554–65.

    Article  Google Scholar 

  29. Diedenhofen B, Musch J. cocor: a comprehensive solution for the statistical comparison of correlations. PLoS One. 2015;10(3):e0121945.

    Article  Google Scholar 

  30. WHO. Accessed 2 Sept 2019.

  31. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8.

    Article  Google Scholar 

  32. Lu MJ, Zhong WH, Liu YX, Miao HZ, Li YC, Ji MH. Sample size for assessing agreement between two methods of measurement by Bland-Altman method. Int J Biostat. 2016.

    Article  PubMed  Google Scholar 

  33. Smulyan H, Sheehe PR, Safar ME. A preliminary evaluation of the mean arterial pressure as measured by cuff oscillometry. Am J Hypertens. 2008;21:166–71.

    Article  Google Scholar 

  34. Wassertheurer S, Hametner B, Sharman J, Weber T. Systolic blood pressure amplification and waveform calibration. Hypertens Res. 2017;40(5):518.

    Article  Google Scholar 

  35. Nakagomi A, Okada S, Shoji T, Kobayashi Y. Comparison of invasive and brachial cuff-based noninvasive measurements for the assessment of blood pressure amplification. Hypertens Res. 2017;40(3):237–42.

    Article  Google Scholar 

  36. Pucci G, Cheriyan J, Hubsch A, Hickson SS, Gajendragadkar PR, Watson T, O’Sullivan M, et al. Evaluation of the Vicorder, a novel cuff-based device for the noninvasive estimation of central blood pressure. J Hypertens. 2013;31(1):77–85.

    Article  CAS  Google Scholar 

  37. Yano Y, Lloyd-Jones DM. Isolated systolic hypertension in young and middle-aged adults. Curr Hypertens Rep. 2016;18:78.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Alejandro Díaz.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest attached to this work.

Ethical approval

All procedures agreed with the Declaration of Helsinki. The study protocol was approved by Institutional Ethic Committee.

Informed consent

Written informed consent was obtained in all subjects.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 3480 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Díaz, A., Bia, D. & Zócalo, Y. Impact of Methodological and Calibration Approach on the Association of Central and Peripheral Systolic Blood Pressure with Cardiac Structure and Function in Children, Adolescents and Adults. High Blood Press Cardiovasc Prev 26, 509–534 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: