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The aim of this study was to evaluate the impact of well controlled blood pressure (BP) levels on structural and functional properties of arteries in essential hypertensives.We studied 80 young hypertensives (mean age 49 yo) allocated either to pharmacological treatment (55 of 80) or to lifestyle modifications (25 of 80) for at least 12 months (mean 38 months) to maintain target BP. Follow-up visits were scheduled every 6 months. Office BP was taken three times by the same doctor at the time of the study. We assessed the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD) of the brachial artery using high-sensitivity ultrasonography. Arterial elastic properties were evaluated by assessing carotid distensibility (DC) and compliance (CC). Forty normotensive subjects paired for age and sex served as controls.Throughout the study, BP levels were well controlled in hypertensives (mean BP levels: 131/79 mmHg). The IMT (mean-IMT 0.65 mm, M-MAX 0.79 mm) was significantly higher in hypertensives than in controls (mean-IMT 0.60 mm, M-MAX 0.70 mm). FMD was impaired in hypertensives (5.7%) compared to controls (9.2%). IMT parameters correlated only to age, while LDL-cholesterol was the only factor related to FMD. Compared to controls, arterial elasticity was significantly impaired in hypertensives (DC 25.6 vs 52.4 10–3/kPa, and CC 0.97 vs 1.40 mm2/kPa).In essential hypertensives, despite long-term well controlled BP, the pro-atherogenic remodelling was still present. IMT was mainly dependent upon age, while FMD was mainly related to cholesterol levels. Moreover, carotid elasticity was impaired. The “pseudo-normalization” of BP levels does not result in normalization of structural and functional properties of the arterial wall.