ConclusionCurrent treatment of hypertension relies on brachial artery BPmeasurement. All cohort studies to date comparing the im-pacts of arterial stiffness, measured by PWV over differentarterial pathways, on one hand, and brachial BP, on the otherhand, show that PWV is the most powerful prognostic indica-tor, independent of and displacing BP. As currently measured,central pressure’sprognosticvalueisnot independent of pe-ripheral BP. Augmentation pressure, in fewer studies, doesseem to be independent of peripheral BP. On these grounds,PWV in its various forms would seem to be a better, indeedmore reproducibly measureable, target than BP alone. Thecomplex relationship between PWVand BP represents a chal-lenge in dissociating their independent effects on cardiovas-cular risk prevention. Trials, including our own, are underwayto test if this is possible.However, of current targets, treatment for isolated systolichypertension, the commonest form of hypertension, remainssuboptimal and is likely to be even more problematic withaging populations. Potential treatments for such pulse pressurewidening include modulating aortic stiffness and the use ofvasodilators such as NO donors with selective action onpulsatile BP components.Therefore, testing in randomised controlled trials whetheroptimising aortic PWV, or in addition to conventional brachialcuff BP, would confer better cardiovascular outcome than BPalone should now be designed on the evidence reviewedabove. Advancing the understanding of pulsatilehaemodynamics will shed light on the haemodynamic originof pulse pressure with aging but also refine both the potential-ly independent but additive impacts of treatment for PWVandfor pulse pressure widening or ‘ISH