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There has been no report investigating the impact of the arterial stiffness reduction induced by antihypertensive medications on the improvement of target organ damage in hypertension. The aim of this study was to assess the association of the change in pulse wave velocity (PWV) with that in urinary albumin excretion as a measure of renal damage.We studied 404 treated hypertensive patients (mean age, 70.5 ± 9.5 years), who were allocated to either an active treatment group (doxazosin and atenolol when needed) or a control group. Blood pressure, urinary albumin-to-creatinine ratio (UACR), and brachial–ankle PWV (baPWV) were measured at baseline and after 6 months of treatment.In the total population, home/office SBP, UACR, and baPWV decreased significantly from the baseline. In multivariate regression analyses, ΔbaPWV was significantly associated with ΔUACR, independent of Δhome SBP (β = 0.21, P < 0.001). When the patients were divided into a group with ΔbaPWV of at least 0 cm/s (positive ΔPWV) and a group with ΔbaPWV of less than 0 cm/s (negative ΔPWV), the reduction of UACR was greater in the latter group, even after adjustment for the covariates including the change in home SBP. These results were essentially the same when office SBP was entered in place of home SBP, and similar both in the active treatment group and the control group.These findings suggest that the arterial stiffness reduction induced by antihypertensive medications is associated with the improvement of renal damage, independent of home/office SBP reduction.