Change in Arterial Compliance as an Early Manifestation of Hypertension

Conclusions: The above findings strongly suggest that measurements of arterial compliance are useful supplements to the routine measurement of blood pressure in the assessment of the structural and functional state of the vasculature. However, efforts to derive benefit from this are frustrated by a lack of consensus regarding the most appropriate techniques and methodologies for determining arterial compliance. Furthermore, some technologies have been granted patent approval and are therefore regarded as trade secrets. This gives the unfortunate impression of a ‘black box’ approach to the measurement of arterial compliance, without full disclosure of all the analytical steps involved. Despite the differing technologies that are available for measuring arterial compliance, the fact that all have almost consistently shown diminished arterial compliance to be associated with both borderline and established hypertension adds further credence to these findings. It may not be so important that the technologies be standardized, but rather that, within a given clinical establishment, one technology is used to evaluate patients over time. In general, review of the literature suggests that measurements of arterial compliance may be useful in various clinical situations. First, among patients with borderline or white-coat hypertension, diminished arterial compliance may identify the subset of patients in whom the presence of abnormal vascular tone or structure justifies chronic antihypertensive therapy. This would be particularly useful if arterial compliance measurements were less variable than clinical blood pressure measurements. Second, measurements of arterial compliance may also be useful in therapeutic monitoring. The preferential use of antihypertensive drugs that have been proven to have a more favorable effect in improving arterial compliance may then eventually serve as a guide to better utilization of antihypertensive drugs. Third, perhaps the best use of measurement of arterial compliance in hypertensive individuals, and maybe also in those with diabetes and hypercholesterolemia, would be that of risk stratification. If longitudinal studies (which need to be conducted if compliance is to become more universally accepted) demonstrate that patients with reduced arterial compliance represent subgroups of individuals who are at particularly high risk for future cardiovascular events, then these individuals could be more aggressively treated and followed, allowing for the optimization of healthcare resources in procuring the maximum reduction in adverse cardiovascular outcome.