Prevention and treatment of excessive arterial stiffness

Abstract Arterial stiffness affecting mainly the aorta and its large branches is currently the subject of numerous studies. Over the years, such arterial stiffness inevitably deepens. Another factor affecting the arterial stiffness is hypertension. Increased arterial stiffness, however, may precede the development of hypertension. The severity of arterial stiffness is more accurate in assessing the risk of complications and death than in knowing the value of blood pressure alone. A number of studies have identified other factors (except age and hypertension) that have a significant impact on the progression of stiffness. These include inflammation, oxidative stress, increased concentrations of glucose, cholesterol, uric acid, and homocysteine in the blood serum. Arterial stiffness occurs especially quickly in patients with renal failure, as well as in those with diabetes and obesity. Recently, a number of authors have drawn attention to the rapid progression of stiffness in some young people, which Nilsson called early vascular aging (EVA). This paper discusses non-pharmacological and pharmacological treatments that can reduce or at least slow down the progression of vascular stiffness measured by pulse wave velocity (PWV). Diets, especially those that reduce the level of overweight in obese people, as well as smoking cessation have a beneficial effect on inhibiting the development of arterial stiffness. Increased exercise plays a major role in inhibiting arterial stiffness progression. Among the pharmacological treatments, antihypertensive drugs play a leading role. All antihypertensive drugs, although to a different extent, inhibit the progression of stiffness. The paper also discusses why patients with atrial fibrillation should use new anticoagulants instead of warfarin.