Background: Increased vascular stiffness has been recently considered a marker of cardiovascular risk and a predictor of cardiac events

Objective: To compare parameters of endothelial dysfunction and carotid atherosclerosis in hypertensive patients presenting increased vascular stiffness.

Methods: A cross-sectional study was carried out to evaluate hypertensive patients, both genders, aged 30–65 years. Macro- and microcirculation parameters were evaluated with measurement of blood pressure (BP), carotid intima-media thickness (IMT), brachial flow-mediated dilation (FMD), peripheral arterial tonometry (EndoPAT), determination of aortic (carotid-femoral) pulse wave velocity (cfPWV) by Complior SP.

Results: Patients (n=70) were divided into Normal cfPWV (<10 m/s, n=31) and High cfPWV (>=10 m/s, n=39) groups. The mean age (49±2 vs 51±2 years) was similar between the groups. High cfPWV group presented greater systolic BP (135±3 vs 145±3 mmHg, p<0.05) and pulse pressure (48±2 vs 57±2 mmHg, p<0.01). Carotid IMT (0.72±0.04 vs 0.90±0.07 mm, p<0.05) and media-lumen ratio (0.10±0.01 vs 0.13±0.01 %, p<0.05) were significantly increased in patients with high cfPWV. On the other hand, brachial FMD (9.74±1.78 vs 9.38±1.38 %) and reactive hyperemia index by EndoPAT (2.12±0.12 vs 2.11±0.08) were not different between the groups. cfPWV was significantly correlated to systolic BP (r=0.37, p<0.01), pulse pressure (r=0.42, p<0.01), and carotid IMT (r=0.33, p<0.05). After multivariate analysis, pulse pressure was the only variable independently associated with cfPWV.

Conclusion: Elevated pulse pressure confirmed to be a clinical indicator of increased central vascular stiffness which is associated with subclinical carotid atherosclerosis even when endothelial function is not significantly impaired in hypertensive patients.