Background: Since arterial stiffness (AS) is one of the factors influencing prognosis in hypertensive patients, we performed a systematic review of studies testing the effect of anti-hypertensive therapy on AS.

Methods: We performed a systematic search of the literature using on-line databases (1966–Dec 2009). We included studies on Pulse Wave Velocity (PWV, m/s -expression of AS) and blood pressure (BP-reported as continuous variable), measured at the beginning and at the end of study, carried out in adult populations after a run-in period. We found one placebo-controlled study (Mitchell, 2007) and 18 reporting a treatment effect in comparison with baseline. For each study, mean difference and 95%C.I. were extracted and pooled using a random effect model.

Results: We identified 19 studies(37cohorts), which included 1,291 participants. The mean observation time was 17 weeks. In the pooled analysis, there was a significant decrease of PWV after treatment (−1.17; 95%C.I.=−1.51,−0.83). In separate analyses the significant PWV reduction was evident with ACE-I (n=12, −1.39; −1.97,−0.82), ARBs (n=7, −1.56; −3.00,−0.12) and Beta-blockers (n=7, −1.03; −1.23,−0.82). While PWV changes with Ca-channel-blockers (n=7, −0.88; −1.84,0.08) and Diuretics (n=3, 0.13; −0.26,0.52) were not significant. There was no publication bias but significant heterogeneity between studies. Meta-regression analysis showed that significant sources of heterogeneity were basal age and BP and BP changes after therapy.

Conclusions: This systematic review suggests that anti-hypertensive treatment improves AS probably with a drug related effect. However the lack of placebo controlled as well as comparative treatment trials do not allows us to reach definite conclusions.