Cardiovascular disease is the number one leading cause of morbidity and mortality worldwide. A large proportion of cardiovascular diseases can be prevented by addressing risk factors and early assessment of target organ damage. The leading cardiovascular risk factor is raised blood pressure, however this relationship is more complex than only the two extremes, systolic and diastolic blood pressure. The pulsatile component of blood pressure plays a role in predicting cardiovascular disease.

The association between arterial stiffness and hypertension is of interest, because the functional relationship is likely bidirectional and can be best described as feed forward in vicious cycle. We confirmed the association of arterial stiffness with isolated systolic hypertension (ISH) and showed that subjects with ISH have a stiffer aorta compared to normotensive subjects and subjects with combined systolic and diastolic hypertension. This difference was most pronounced at older age.

Heart failure is a growing health problem in the aging population. To improve treatment of heart failure, the mechanisms regarding development of heart failure should be unraveled. We confirmed the relation between SBP and heart failure and demonstrated that both pulse pressure and aPWV are associated with the development of heart failure.

Population-wide primary prevention and individual health-care intervention strategies for cardiovascular disease have contributed to declining mortality trends. If people at risk for developing cardiovascular disease can be identified and measures taken to reduce their cardiovascular risk, a vast majority of fatal and non/fatal cardiovascular events can be prevented. We have added aortic stiffness to the Framingham risk factors and determined if the risk classification for CHD improved. However, the addition of aortic stiffness led to minor reclassification of subjects within 10-year cardiovascular disease risk categories, suggesting low additional value of aortic stiffness in the clinical management of CHD in the elderly.