Background: The possible relationships between indicators of small resistance artery structure and of large artery distensibility have not yet been evaluated. Aim: to assess the relationship between carotido-femoral pulse wave velocity (CF-PWV), central blood pressure (cBP) and vascular alterations in small resistance arteries (media to lumen ratio, M:L) in patients with primary and secondary hypertension Patients and methods: In 65 patients (mean age 53±14 years, 31 F, 21 with diabetes mellitus type 2, 14 never treated) with essential (n= 32) and secondary (n=33) hypertension, pulse wave velocity was measured (Complior)and PW analysis was performed (Sphygmocor). In all patients small-resistance arteries were dissected from subcutaneous fat biopsies and mounted on an isometric myograph, for the measurement of the M:L. Results: Mean values of PWV and of M:L ratio were 11.4±2.6 m/s and 0.09±0.019, respectively. M:L ratio was significantly related to brachial systolic blood pressure (SBP) and pulse pressure (PP) (r=0.40 and 0.39, p<0.001, respectively) and to central SBP and PP (r=0.44 and 0.46, p<0.001, respectively). A positive correlation was observed between M:L and PWV (r=0.43, p< 0.001); this correlation remained statistically significant after adjustment for age and SBP (beta= 0.29, p=0.03). M:L ratio was also associated to augmentation pressure (r=0.42, p< 0.001); again this correlations remained statistically significant after adjustment for age, gender, mean BP and also for CF PWV. Conclusions: In hypertensive patients the presence of structural alterations of small resistance arteries may be associated with the increase in large arteries stiffness and, possibly contribute to an increase in central pressure by earlier wave reflections.