Stiffness of elastic arteries like the aorta predicts cardiovascular risk. By directly reflecting arterial stiffness, having the best predictive value for cardiovascular outcome and the ease of its measurement, carotid-femoral pulse wave velocity is now considered the gold standard for arterial stiffness assessment in daily practice. Many different measurement procedures have been proposed. Therefore, standardization of its measurement is urgently needed, particularly regarding the distance measurement. This consensus document advises on the measurement procedures in general and provides arguments for the use of 80% of the direct carotid-femoral distance as the most accurate distance estimate. It also advises the use of 10 m/s as new cut-off value for carotid-femoral pulse wave velocity.

AimsCarotid–femoral pulse wave velocity (PWV), a direct measure of aortic stiffness, has become increasingly important for total cardiovascular (CV) risk estimation. Its application as a routine tool for clinical patient evaluation has been hampered by the absence of reference values. The aim of the present study is to establish reference and normal values for PWV based on a large European population.Methods and resultsWe gathered data from 16 867 subjects and patients from 13 different centres across eight European countries, in which PWV and basic clinical parameters were measured. Of these, 11 092 individuals were free from overt CV disease, non-diabetic and untreated by either anti-hypertensive or lipid-lowering drugs and constituted the reference value population, of which the subset with optimal/normal blood pressures (BPs) (n = 1455) is the normal value population. Prior to data pooling, PWV values were converted to a common standard using established conversion formulae. Subjects were categorized by age decade and further subdivided according to BP categories. Pulse wave velocity increased with age and BP category; the increase with age being more pronounced for higher BP categories and the increase with BP being more important for older subjects. The distribution of PWV with age and BP category is described and reference values for PWV are established. Normal values are proposed based on the PWV values observed in the non-hypertensive subpopulation who had no additional CV risk factors.ConclusionThe present study is the first to establish reference and normal values for PWV, combining a sizeable European population after standardizing results for different methods of PWV measurement.

IMPORTANCE Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes.OBJECTIVE To evaluate the association of BP indexes with death and a composite CV event.

Systolic blood pressure and heart rate measured at rest and during a standardized exercise test were analyzed in the cohort of middle-aged male employees followed-up an average of 17 years in the Paris Prospective Study L The population sample selected for the analysis included 4,907 men who completed at least 5 minutes of bicycle ergometry, who had no heart disease at entry, and whose resting blood pressure was s 180/105 nun Hg. Exercise-induced increase in systolic blood pressure was positively correlated with resting systolic blood pressure (r=0.104, p<0.0001), whereas the correlation of exerciseinduced heart rate increase with resting heart rate was negative (r=-0.169, p<0.0001). Using Cox regression analysis with the inclusion of resting systolic blood pressure and heart rate; exercise-induced elevations of systolic blood pressure and heart rate; and controlling for age, smoking, total cholesterol, body mass index, electrical left ventricular hypertrophy, and sports activities, cardiovascular mortality was found to be associated with the systolic blood pressure increase (p<0.05), whereas no association with resting systolic blood pressure was found. Total mortality was predicted by resting systolic blood pressure and its elevation (p<0.01 for both) and by resting heart rate (p<0.0001). The heart rate increase did not contribute to death prediction. In conclusion, the magnitude of the exercise-induced increase of systolic blood pressure, but not of heart rate, may represent a risk factor for death from cardiovascular as well as noncardiovascular causes, independently of resting blood pressure and heart rate. (Hypertension 1992^0-333-339) KEY WORDS • blood pressure • heart rate • exercise test • prospective studies • mortality A rterial blood pressure (BP) is a strong determi-/ \ nant of life prognosis, and cardiovascular A. A . (CV) as well as total mortality are definitely higher in subjects who are classified as hypertensive according to BP measurement at rest. Although relatively less attention has been drawn to heart rate (HR) level, it was also found to be associated with mortality.1 There is a logical tendency to measure these two parameters in basal conditions at rest to achieve maximal standardization; however, it does not imply that this way of assessing BP and pulse rate is the most predictive of individual risk. Exercise testing yields important 'information about circulatory status and perhaps about life prognosis since it may reflect, with other factors, physical fitness and presence or absence of coronary atherosclerosis.Exercise tests are widely used in patients in whom coronary heart disease is suspected, and the strong predictive value of pathological electrocardiographic changes, mainly of the ST segment, has been confirmed several times.2 -4 Several authors have studied BP and HR changes on physical load in various populations 4 -3 ; however, the prognostic value of these parameters in an intact population remains unestablished. Recently, Fagard et al 6 published interesting results on...

The international database of ambulatory blood pressure in relation to cardiovascular outcome will provide a shared resource to investigate risk stratification by ambulatory blood pressure monitoring to an extent not possible in any earlier individual study.