The effects of antihypertensive drugs on arterial stiffness

•Ageing and hypertension induce arterial stiffness leading to organ damage.•Aortic stiffness is independently associated with adverse cardiovascular events.•Pressure wave reflection is also associated with poor cardiovascular outcome.•Blood pressure reduction improves arterial stiffness and wave reflections.•Some antihypertensive drugs have beneficial effects beyond lowering blood pressure.

Ageing and cardiovascular risk factors, particularly uncontrolled hypertension, adversely impact arterial stiffness and wave reflection leading to increased central systolic blood pressure. Carotid-femoral pulse wave velocity is the “gold standard” method for the assessment of aortic stiffness. Increased pulse wave velocity has been independently associated with adverse cardiovascular outcomes. Thus, current European hypertension guidelines acknowledge the reproducibility, predictive value, and cost-effectiveness of pulse wave velocity.Augmentation index, a marker of arterial stiffness and wave reflection has been also associated with poor cardiovascular outcome.Current evidence suggests that increased arterial stiffness and wave reflection contribute to target organ damage. Thus, early intervention is fundamental for cardiovascular prevention. Elevated pulse wave velocity and augmentation index can be reduced by normalizing blood pressure and by using specific treatments for reducing arterial stiffness.This article will review the available evidence on the effect of the different antihypertensive drug classes on arterial stiffness. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers can reduce pulse wave velocity beyond the blood pressure lowering effect. Although blood pressure normalization is the most effective therapeutic tool for reducing parameters of wave reflections, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers have beneficial effects on augmentation index.