Assessment of arterial stiffness in clinical practice

There has been much recent interest in the relationship between arterial stiffness and cardiovascular disease. Pulse pressure and pulse wave velocity, surrogate measures of arterial stiffness, indicate that arterial stiffness increases both with age and in certain disease states that are themselves associated with increased cardiovascular risk, including hypertension, diabetes mellitus, hypercholesterolaemia and end‐stage renal failure.1 As changes can be detected before the appearance of clinically apparent vascular disease, arterial stiffness may act either as a marker for the development of future atherosclerotic disease, or may be more directly involved in the process of atherosclerosis. Arterial stiffening has been particularly implicated in the development of isolated systolic hypertension, a disease mainly affecting the elderly population and associated with considerable excess morbidity and mortality. Arterial stiffness may be measured using a variety of different techniques, although at present the majority of measurements are made for experimental and physiological studies rather than in clinical practice. However, it is likely that over the next few years measurement of arterial stiffness will become an increasingly important part of the process of risk assessment, and may possibly also improve the monitoring of therapy in patients with conditions such as isolated systolic hypertension. Therefore, it will become necessary for physicians both in primary care and hospital practice to understand the importance of arterial stiffness and the techniques available for its clinical assessment, which will be the focus of this review. Assessment of the arterial pulse has always been an important part of clinical examination, and the ancients recognized that changes in the character of the pulse indicated the presence of disease. However, the ‘golden era’ of the pulse was the 19th century. With the development of the sphygmograph by Marey2 and its refinement over the next few years by Mahomed,3 Broadbent4 and …