Is arterial stiffness better than blood pressure in predicting cardiovascular risk?

Abstract  Measurement of systolic and diastolic pressure by cuff sphygmomanometer originally restricted our view of the underlying mechanisms of blood pressure to cardiac strength and peripheral resistance. As effects of arterial stiffening on the heart and vasculature became apparent over the past two decades, the focus changed from diastolic to systolic pressure and then to pulse pressure. Brachial pulse pressure was recognized as a measure of stiffness and predictor of cardiovascular risk, and then central aortic systolic and pulse pressure came into favor. Now the relationship of systolic to diastolic pressure in ambulatory recordings is seen as another, perhaps better, predictor. New measures have emerged from the analysis of arterial pulse wave forms. These measures, pulse wave velocity and augmentation index, can be obtained relatively easily and reproducibly in the clinic. Many studies suggest that these are the best predictors of risk—even targets for therapy—and give incremental information over conventional values of arterial pressure.