Arterial stiffness, its assessment, prognostic value, and implications for treatment

Arterial stiffness has been known as a sign of cardiovascular risk since the 19th century. Despite this, accurate measurement and clinical utility have only emerged in recent times. Arterial stiffness and its hemodynamic consequences are now established as predictors of adverse cardiovascular outcome. They are easily and reliably measured using a range of noninvasive techniques, which can be used readily by risk assessment facilities or individual practitioners. The techniques described in this review are based on the pulsatility of the cardiovascular system, utilizing the timing of pulse travel along major arteries and the magnitude of wave reflection. These have enabled better understanding of the ill effects of arterial stiffening, not only on large arteries and the left ventricle, but also on tiny arteries in highly perfused organs such as brain and kidneys. Treatment options, which directly target the consequences of arterial stiffening, as opposed to arbitrary reduction of brachial blood pressure, have proved clinical superiority; optimal therapy entails use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium-channel blockers, as well as vasodilating β-blockers. Arterial stiffness will undoubtedly contribute to cardiovascular assessment and management in future clinical practice. Reviews such as this will hopefully increase awareness of the mounting evidence underlying this transition, and the relevant theory and methodology. As we begin the second decade of the 21st century, we are finally collectively coming to realize what pioneers such as Osler, Roy, Bramwell and Hill foresaw in the 19th and 20th centuries.