Arterial stiffness: From surrogate marker to therapeutic target

•Standardisation of carotid-femoral pulse wave velocity (PWV) is urgently needed.•Carotid-femoral (aortic) PWV is the current standard for arterial stiffness.•Aortic PWV added to classical cardiovascular risk scores can reclassify patients.

Carotid-femoral (aortic) pulse wave velocity (PWV) is the modern benchmark for the assessment of arterial stiffness. Current European hypertension guidelines acknowledge the good cardiovascular (CV) predictive value, reproducibility and cost-effectiveness of PWV. Aortic PWV is an asset to classical cardiovascular risk scores and can reclassify patients. Reference values for carotid-femoral PWV have been established. Together with standardisation of user procedures and patient conditions, these reference values are needed for an appropriate use of aortic stiffness in daily clinical practice. Finally, the existing evidence for a decrease in CV risk by decreasing aortic stiffness is discussed.