Invited review
Large artery damage in hypertension

Arterial stiffness and wave reflections, which are now well accepted as the most important determinants of increasing systolic and pulse pressures in ageing societies, reflect large artery damage in hypertension. These parameters are increasingly used in the clinical assessment of patients with hypertension and various cardiovascular (CV) risk factors. This review addresses recent advances in our understanding of the role played by arterial stiffness and wave reflection in the pathophysiology and treatment of hypertension. We also report a large number of longitudinal epidemiological studies demonstrating the independent predictive value of arterial stiffness, carotid pulse pressure and augmentation index, for cardiovascular events, and show that these parameters are now well accepted as intermediate end-points for CV events. We also discuss the effects of pharmacological agents on aortic stiffness and wave reflections. A remaining major issue is to determine whether a reduction in PWV or wave reflection in hypertensive patients is associated with a concomitant reduction in CV events, independently of the normalization of classical CV risk factors.