Carotid–femoral pulse wave velocity (PWV) is considered the gold standard for arterial stiffness assessment in clinical practice. A large number of devices to measure PWV have been developed and validated. We reviewed different validation studies of PWV estimation techniques and assessed their conformity to the Artery Society Guidelines and the American Heart Association recommendations. Pubmed and Medline (1995–2017) were searched to identify PWV validation studies. Of the 96 article retrieved, 26 met the inclusion criteria. Several devices had been developed and validated to noninvasively measure arterial stiffness, using applanation tonometry (SphygmoCor, PulsePen), piezoelectric mechanotransducers (Complior), cuff-based oscillometry (Arteriograph, Vicorder and Mobil-O-Graph), photodiode sensors (pOpmètre) and devices assessing brachial-ankle pulse wave velocity and cardiac-ankle PWV. Ultrasound technique and MRI remain confined to clinical research. Good agreement was found with the Artery Society Guidelines. Two studies (Complior, SphygmoCor Xcel) showed best adherence with the guidelines. In Arteriograph, MRI, ultrasound and SphygmoCor Xcel validation studies sample size was smaller than the minimum suggested by the guidelines. High discrepancies between devices were shown in distance estimation: in two studies (Arteriograph, Complior) path length was estimated in conformity to the guidelines. Transit time was calculated using the intersecting tangent method, but in two studies (Vicorder, pOpmètre) best agreement was found using the maximum of the second derivative. Six studies reached the accuracy level ‘excellent’ defined in the Artery guidelines. Method to assess transit time and path length need validation in larger populations. Further studies are required in different risk population to implement clinical applicability of every device.

Objectives: The objectives of this study were to evaluate the prevalence of dilatation of proximal ascending aorta (pAA) in essential hypertensive patients and the association between pAA dilatation, arterial stiffness and left ventricular hypertrophy. Background: Few data are available regarding patients with pAA dilatation in arterial hypertension. It is not known whether pAA dilatation may be related to increased left ventricular mass and what the relation with central hemodynamics and arterial stiffness would be. Methods: A total of 345 untreated and treated essential hypertensive patients (mean age, 54.3 ± 11 years) were considered for this analysis. We measured pulsatile hemodynamic parameters directly using tonometry, and the proximal aortic diameters through ultrasound imaging (echocardiography). Results: Prevalence of pAA dilatation was 17%. Peripheral hemodynamic parameters were similar in patients with and without ascending aorta dilatation. We observed a slight increase of central systolic (129.81 ± 15.4 vs. 125.02 ± 14.7 mmHg; P = 0.02) and pulse pressure (45.02 ± 10.4 vs. 42 ± 9.54 mmHg; P = 0.02) in patients with pAA dilatation. Pulse wave velocity (9.26 ± 2.33 vs. 7.70 ± 1.69 m/s; P < 0.0001), as well as the augmentation index (25.86 ± 10.2 vs. 19.41 ± 9.52%; P < 0.0001), was significantly greater in patients with pAA dilatation. Finally, left ventricular hypertrophy was thrice as frequent (32.8 vs. 13.4%; P < 0.0001) compared to hypertensive patients without aortic dilatation. Conclusion: This study shows a high prevalence (17%) of ascending aortic dilatation in patients affected by essential hypertension, without further complications. Dilatation of the ascending aorta is associated both to an increased left ventricular mass and arterial stiffness.

Background: Aortic root dilatation (ARD) and arterial hypertension represent two important risk factors for aortic dissection: prevalence of observed ARD is increasing – up to 12% in the latest available reports. A recently published work tested on a good number of healthy individuals new reference ranges for aortic root dimensions, suggesting new reference values with corrections for age, gender, height (pHeight) or body surface area (pBSA). Aim: The aim of the study was to evaluate the prevalence of ARD in hypertensive patients using various criteria. Methods: A total of 1076 untreated and treated essential hypertensive patients (mean age, 52.5 ± 2 years) were considered for this analysis. We measured proximal aortic diameters using ultrasound imaging (echocardiography). ARD was defined in three ways. First, when the observed aortic diameter was larger than that predicted for age, sex, and BSA (pBSA), second when larger than predicted by height (pHeight), and third when the aortic diameter to BSA ratio (ASi) was at least 2.1 cm/m². Results: A total of 237 patients (22% of the study population) showed at least one among the three different criteria defining aortic dilatation. Prevalence of ARD, considering singularly each one of the criteria, varied between 12.8% (pBSA) and 16.9% (pHeight). Conclusion: Our study demonstrated a prevalence of ARD higher than previously reported. Our data suggest, therefore, the necessity of a correct choice of the diagnostic criterion that has to be applied in the single patient for definition of ARD. In particular, using the criterion pHeight in obese patients, we may avoid underdiagnosis of this condition.