Background & Objective: 87,481 data between 54 centres were combined, to establish reference values for central systolic blood pressure (cSBP). Although cardiovascular risk factors (CVRFs) are associated with cSBP, the individual strengths of their relationships are weak and the combination of some CVRFs into metabolic syndrome (MetS) could have a stronger association.

Methods: We selected 8,057 subjects untreated for hypertension, dyslipidemia or diabetes, and devoid of known CV disease, whereby all required variables were available. CVRFs, CV disease and MetS were defined according to the 2007 ESH-ESC Hypertension Guidelines. We used multivariable regression analysis of cSBP according to the number of CVRFs and the presence of MetS.

Results: The median number of CVRFs was 2 (IQR: 2–3, range: 0–5). Number of CVRFs was strongly linked to cSBP, increasing by 7 mmHg per CVRF, though there was less of an increase when the analysis was stratified by those having brachial BP >= 130/85mmHg (‘high normal’ and above) and those not (beta coefficients = 4.0 and 1.5, respectively). The presence of MetS was related to cSBP to a lower extent (beta coefficient = 2.5) with insufficient evidence for an association when the analysis was adjusted according to BP status (beta coefficients = −1.8 and 0.4 within low and high BP groups, respectively).

Conclusions: In these subjects, when adjusting for high normal BP, cSBP is still strongly influenced by the cumulative number of CVRFs. The association between MetS and cSBP is mainly driven by the inclusion of high normal BP in its definition.

Table 1

cSBP values stratified by metabolic syndrome and brachial BP status