Background-Aim: The degree of blood pressure reduction remains the corner stone of a successful treatment in hypertension. Various parameters have been evaluated in order to predict the response to drug treatment, but no single marker has been found to predict the response to blood treatment. Arterial stiffening is a dominant trait of aging and is further accelerated by numerous cardiovascular risk factors which have been evaluated as predictors of the response to antihypertensive drug treatment. We sought to investigate whether baseline arterial stiffness is a predictor of the response to drug treatment.

Methods: 375 subjects were investigate in an intention to treat prospective study and were randomly allocated to receive atenolol 50 mg or perindopril 4 mg/indapamide 2.5 mg, for 12 months. Carotid-femoral pulse wave velocity (PWV) and classical cardiovascular risk factors were assessed at baseline.

Results: PWV was a predictor of systolic and diastolic blood pressure change after 12 months, independently from age, gender, medication, cardiovascular risk factors and baseline blood pressure. Similarly, PWV was also an independent predictor of the presence of effective blood pressure control after 12 months of treatment. Finally, those subjects within the highest tertile of baseline PWV, demonstrated the lowest blood pressure reduction after 12 months, even after adjustment for age, gender, medication and baseline blood pressure.

Conclusion: Increased large artery stiffness is associated and predicts reduced response to antihypertensive drugs; future investigations are needed to show whether it could be a useful tool in clinical use.