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Aging causes progressive changes in the structure and function of the large arteries that adversely impact the heart and vital organs. Vascular aging is a major independent risk factor for the development of cardiovascular diseases and events. Arterial stiffening is the dominant hemodynamic manifestation of vascular aging and a major independent predictor for incident hypertension. Arterial stiffening is therefore responsible for the very high residual lifetime risk for hypertension for middle-aged and elderly individuals.

Asian populations may have a predisposition to increased central aortic pulse pressure because of the relatively larger diameter and thinner media at the proximal aorta that affect the interaction between ventricular ejection and arterial load. Increased arterial stiffness with aging was confirmed in several Asian populations, using either carotid-femoral pulse wave velocity (cf-PWV) or brachial-ankle pulse wave velocity (ba-PWV). Both cf-PWV and ba-PWV have been recognized as an independent predictor for cardiovascular events and all-cause mortality in Asian populations. In Asian populations, vascular aging-related medial degeneration but not atherosclerosis is the dominant factor associated with increased arterial stiffness with age. Salt intake has an independent effect on arterial wall properties contributing to increased arterial stiffness with age.

Systolic hypertension is a consequence and an accelerator of the vascular aging related arterial stiffness. Asian subjects with systolic hypertension may be more prone to risks of cardiovascular disease, mortality and renal function decline than Western subjects. Strategies to prevent arterial stiffness and control systolic hypertension are urgently needed for the rapidly aging Asian populations.

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