title: Arterial (Aortic) Stiffness in Patients with Resistant Hypertension: from Assessment to Treatment.
abstract: OBJECTIVE
  The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH).
  
  
  RESULTS
  Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH. This issue needs resolution as it could help refine management decisions guided by aortic stiffness. If conventional antihypertensive therapy fails to lower BP in patients with RH, there is good rationale for effectiveness of spironolactone as add on therapy, and this should also improve aortic stiffness. Lifestyle intervention with exercise and diet should be additionally efficacious towards improving BP and aortic stiffness in patients with RH, but there is limited data in this patient population. For better characterization on the effects of BP treatment on aortic stiffness, measures of central aortic BP may help refine management decisions above and beyond conventional arm cuff BP. There is strong evidence to support the use of aortic stiffness as a tool to aid risk stratification in hypertension management. Although there is a theoretical basis for special additional benefit of measuring aortic stiffness in patients with RH (as distinct from uncomplicated hypertension), at this time, there is inadequate data available to make definitive conclusions and is an area for future investigation.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, Australia. James.Sharman@utas.edu.au.
authors.forename: James E
authors.initials: JE
authors.lastname: Sharman
authors.affiliation: Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.affiliation: Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000187:drug effects; D062186:Arterial Pressure; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents
keywords: Blood vessels; Cardiovascular systems; Drug therapies; Hemodynamic; Pharmacotherapies