Antihypertensive therapy and de-stiffening of the arteries.

IMPORTANCE OF THE FIELD: There is no doubt as to the existence of a significant relationship between the pulsatile blood pressure component and cardiovascular risk. In hypertensive subjects, cardiovascular event risk reduction is mainly associated with the normalization of systolic blood pressure. Systolic blood pressure and pulse pressure in the ascending aorta exceeds brachial systolic and pulse pressure significantly. AREAS COVERED IN THIS REVIEW: The aim was to provide a review of the scientific data on pharmacologic interventions leading to reduction in aortic stiffness and/or wave reflections (de-stiffening therapy). WHAT THE READER WILL GAIN: Most of the protocols used in clinical trials to de-stiffen arteries (i.e., to influence wave reflections and/or arterial wall stiffness) required the administration of agents blocking renin-angiotensin system, which was frequently combined with a diuretic or a calcium antagonist. TAKE HOME MESSAGE: It is possible to obtain a selective and long-term reduction of brachial and - even more importantly - central pulse pressure by decreasing arterial stiffness and/or wave reflections.