These last years, the widespread use of regional pulse wave velocity in clinical practice has overlooked the usefulness of local arterial stiffness. Indeed, the elastic properties of large superficial arteries (carotid, femoral, brachial and radial) can be assessed locally through the systolic-diastolic variations in arterial lumen diameter and thickness using high resolution echotracking systems, and local pulse pressure using aplanation tonometry. The mechanical properties of deep arteries like the thoracic aorta can be assessed using cine magnetic resonance imaging (MRI).

The aim of this review is to discuss how the measurement of the geometrical and functional properties of large arteries contributed to important conceptual achievements in arterial mechanics. Several aspects are discussed that concern the pathophysiology, pharmacology and epidemiology of arterial stiffness. We explain (1) how the precise phenotyping of the changes in large and small artery during essential hypertension can enter a vicious circle of aggravation named large/small artery cross-talk; (2) how the understanding of the wall material elastic properties that are associated with arterial wall hypertrophy in essential hypertension, has lead to the discovery of putative novel mechanisms involved in arterial stiffness; (3) how local measurements of arterial stiffness can help to find the true pathway followed by the pressure wave, when a single-site measurement/arm cuff oscillometric method is used; (4) how the study of arterial remodeling and mechanics during long-term antihypertensive treatment can unmask a blood-pressure independent reduction in arterial stiffness; and, finally (5) how carotid stiffness can predict cardiovascular events independently of regional pulse wave velocity.