Arterial stiffness, pulse pressure, and cardiovascular disease-is it possible to break the vicious circle?

Hypertension is strongly associated with cardio/cerebrovascular diseases, e.g. myocardial infarction, stroke, and heart failure, which are main causes of cardiovascular morbidity and mortality. In hypertensive subjects, cardiovascular risk reduction is mainly associated with reduction in brachial systolic blood pressure (SBP). As it was shown in controlled and long-term therapeutic trials, it is possible to produce a selective SBP reduction through a specific "de-stiffening" strategy. This means that SBP reduction is obtained independently of mean arterial pressure change, using a significant and selective reduction of wave reflections and/or aortic stiffness. The procedure is especially effective in decreasing central systolic and pulse pressures, which were shown to be major determinants of long-term outcome. As some concerns associated with decreasing in diastolic blood pressure to low values (so called "J-curve" phenomenon) have been raised recently the de-stiffening strategy appears to be especially attractive. Most of the protocols used to de-stiffen large arteries required the administration of a renin-angiotensin-aldosterone system inhibitor, which frequently was associated with a diuretic and/or a calcium antagonist, but not with a classic beta-blocker. These protocols were evaluated in randomized controlled trials and showed significant reduction in cardiovascular risk, particularly in comparison with beta-blockers.