Objective: Arterial stiffness as carotid-femoral Pulse Wave Velocity (PWV) has been included in the European guidelines for the management of arterial hypertension as target organ damage (TOD). This study is aimed at determining the usefulness of PWV beyond other measures of TOD in risk stratification of hypertensive patients.

Design and Methods: 234 patients (56.6 ± 12.0 years; 135 men; 85% already under antihypertensive therapy) were enrolled among those referring to the Hypertension unit for a program including medical history, physical examination, blood pressure (BP) measurement, blood and urine samples with lipid profile, glucose, creatinine, and microalbuminuria, EKG, echocardiography, carotid ultrasound and PWV. A threshold of 8.3 m/s was used as marker of increased PWV.

Results: With history, examination, BP, and blood and urinary exams, patients were classified at low (33%), moderate (33%), high (29%), or very high (5%) added risk. Median PWV was 7.88 (25th–75th percentile 7.05–8.95) m/s. Patients reclassified to an higher risk class were 21% by adding PWV, 14% by echocardiography, and 50% by carotid ultrasound. When all TOD markers except PWV were used, patients were classified as low (6%), moderate (23%), high (66%), or very high (5%) risk. Adding PWV detected TOD in 10 further patients, but only 3 of them were reclassified into higher category.

Conclusions: PWV is useful to classify low and moderate risk patients, but it adds little in patients already studied with cardiac and carotid ultrasound. Its advantage over other measures could be represented by the low cost and expertise required.