Arterial stiffness: reflections on the arterial pulse

Arteriosclerosis—arterial stiffening—is the basic cause of isolated systolic hypertension (ISH) and the present epidemic of heart failure in the elderly.1 Arteriosclerosis is equally important for the development of coronary events, stroke, dementia, and renal failure. The underlying pathology was described by Osler2 as ‘senile arteriosclerosis’ to distinguish it from essential hypertension (Osler's ‘diffuse arteriosclerosis’) and ‘nodular arteriosclerosis’ that is now described as atherosclerosis. Although we usually identify the precursor as ISH, the measurement of blood pressure by cuff sphygmomanometer is only a surrogate of the underlying disease3 and an unsatisfactory method for detecting its early presence and progress. Recognizing this, the European Societies of Cardiology and of Hypertension (ESC and ESH, respectively) established guidelines for the management of arterial hypertension, and drew attention to methods for measuring arterial stiffness as pulse wave velocity or analysing the pulse waveform, which may identify the arterial target organ damage at an early stage.4 An important step in this field is the publication of a consensus document on arterial stiffness from a European group in good standing with professional associations, and led by Stephane Laurent.9 Specific statements are given on key issues, based on review and mechanism, practicality of measurement, and evidence of value. The document is a logical development from previous statements and publications including the most recent Handbook of Hypertension5 to which most authors contributed. It is timely, since the ESC and ESH are reviewing guidelines on management of hypertension in the light of new information that has emerged since the last publication.4 Why is this necessary when ISH can be recognized years before development of cardiac failure, and can be (but often is not) treated effectively? The problem is with cuff blood pressure measurement—its accuracy when measured simultaneously by different methods, its accuracy in … *Corresponding author. Tel: +61 2 8382 6874; fax: +61 2 8382 6875. E-mail address : M.ORourke{at}unsw.edu.au