Stiffening of large arteries is considered as an independent predictor of cardiovascular events. This article summarizes recent theories on the mechanisms contributing to arterial stiffness involving extracellular matrix proteins, endothelial and smooth muscle cells, cell-matrix interactions, and genetic background. Despite the important role of genetic factors in essential hypertension, little is known about the genetic of arterial stiffness. In the future, candidate genes approaches will allow to determine the cellular and molecular mechanisms of arterial stiffness. A review of different strategies aimed at lowering arterial stiffness and potentially reducing cardiovascular risk are presented. Lifestyle changes and antihypertensive drugs have showed beneficial effects in reversing stiffness. New emerging tools as gene therapy and molecules involved in matrix attachments or crosslink of collagen may be promising. Therapeutic trials using such strategies will be necessary to demonstrate their impact on morbidity and mortality.
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