Dual benefits of renin-angiotensin-aldosterone blockade: lowering the blood pressure and de-stiffening the arteries

Stiffening of arteries is due to the loss of elasticity and compliance in the diseased media (1). Arterial stiffness raises systolic blood pressure (BP) and further increases left ventricular (LV) afterload and myocardial oxygen demand (2). Arterial stiffness also causes decreased diastolic BP and subsequent reduction of coronary perfusion (3). The elevated systolic BP and decreased diastolic BP together result in higher pulse pressure, which leads to fragmentation of elastin in the aorta and damages high-flow, low-resistance cerebral and renal circulation as well. Along the stiffened arterial trees, pulse wave propagation accelerates and wave reflection from the periphery towards the heart occurs earlier and more proximally, so that the central BP is increased (3).