Determinants of Arterial Stiffness

Paramount Clinical Evidence

Stiffening of the arterial vasculature in general has been recognized as a typical pattern of vascular aging, an established and documented knowledge in clinical medicine for a long time. Only during the recent decades though, stiffening of the arterial tree, in particular the large central vessels, has been researched and systematically evaluated. The resulting evidence shows a striking association to cardiovascular disease in all ages and a direct link to systolic hypertension, coronary artery disease, stroke, and heart failure, not limited to populations of the Western world, but extending to the Middle East and the fast growing metropolitan societies around the globe.
As age and hypertension are drivers of stiffening [16], the concept of Arterial Stiffness is finally reshaping the clinical thinking and approach in hypertension management.

Excellent reading provides Chirinos et al. in [13], offering a comprehensive insight into the physiology, pathophysiology, and clinical relevance:

“Large-artery (aortic) stiffening, which occurs with aging and various pathologic states, […] has important consequences on cardiovascular health, including isolated systolic hypertension, excessive penetration of pulsatile energy into the microvasculature of target organs that operate at low vascular resistance, and abnormal ventricular-arterial interactions that promote left ventricular remodeling, dysfunction, and failure. Large-artery stiffness independently predicts cardiovascular risk and represents a high-priority therapeutic target.”

Arterial Stiffness Testing

Several consensus papers document both the need and the foundations of stiffness testing, determining aortic Pulse Wave Velocity (aPWV) as the parameter of choice for stratifying risk and evaluating the detrimental course of cardio-vascular disease [17, 18]. In addition, Pulse Wave Analysis (PWA) allows thorough differential diagnostics. With up-to-date instruments both testing modalities are operator-independent and require moderate expense or testing time.