Morbidity and mortality in hypertension are mainly determined by arterial l
esions which may occur in different regional circulations: kidney, cerebral
, coronary..., causing respectively nephroangiosclerosis, stroke or myocard
ial infarction... Despite the arteries heterogeneity, structural and functi
onal abnormalities are usually observed at an early stage of hypertension i
n both large and small arteries. These alterations modify arterial wall phy
siological and mechanical properties which can be expressed clinically by i
ncreasing arterial pulsatility or pulse pressure; they facilitate establish
ment and progression of atherosclerosis and arteriosclerosis. Since arterie
s constitute the target, site and common denominator of hypertension cardio
vascular complications, several noninvasive techniques may be usefull to as
sess their haemodynamic: casual and ambulatory blood pressure measurements
can evaluate pulse pressure which can be also directly measured in differen
t sites of the arterial tree using the "Tonometer" device; ultrasound techn
iques can be applied: Doppler signal to assess the arterial flow, video-ech
o signal to analyse the arterial structure such as intima-media thickness,
or echo-tracking systems for direct measurements of arterial wall distensio
n and thickness; pulse wave velocity is widely used as index of arterial di
stensibility; its assessment, using the Complior(R) device showed that hype
rtensive patients present a decrease of arterial distensibility and that an
tihypertensive treatment do not always reverse this abnormality. Since card
iovascular morbidity and mortality are due to arterial lesions, it is impor
tant to evaluate the effect of cardiovascular prevention on the arterial wa
ll. Large therapeutical trials, including arterial evaluation, are necessar
y to assess whether this consideration may particularize patients with high
cardiovascular risk and contribute to their treatment and prognostic impro
vement.