When we think about heart health, we usually think about blood pressure, cholesterol, blood sugar or heart rate. But there is another aspect of cardiovascular health that is less familiar to many patients: arterial stiffness.

Our arteries are not rigid pipes. Healthy arteries are flexible and elastic. They expand when the heart pumps blood and then recoil between heartbeats, helping blood flow smoothly around the body.

As we age, arteries naturally become less elastic. However, high blood pressure, diabetes, smoking, high cholesterol and other cardiovascular risk factors can accelerate this process.

Arterial stiffness matters because it can be an indicator of changes occurring within the cardiovascular system before a person develops obvious symptoms.

As an internal medicine specialist and hypertension expert in Singapore, I consider the condition of the blood vessels as part of the bigger picture when assessing cardiovascular risk, particularly in patients with hypertension or multiple risk factors.

What is arterial stiffness?

Arterial stiffness occurs when the walls of the arteries become less flexible and less able to expand and contract normally.

One of the most established ways of assessing arterial stiffness is pulse wave velocity (PWV).

Every time your heart beats, it creates a pressure wave that travels through the arteries. In a more elastic artery, the wave travels relatively slowly. In a stiffer artery, it travels faster.

Carotid-femoral pulse wave velocity is considered an established method for assessing large artery stiffness. [1]

The 2024 European Society of Cardiology guidelines recognise pulse wave velocity as one of the tests that can provide additional information about cardiovascular risk and hypertension-mediated organ damage in selected patients. [2]

However, arterial stiffness is not something that every healthy person needs to have measured routinely. It is generally used selectively, particularly when the result could help clarify cardiovascular risk or influence clinical management.

Why do arteries become stiff?

Ageing is one of the strongest factors associated with arterial stiffening. But age is not the only factor.

Several conditions and lifestyle factors can contribute, including:

• Long-standing high blood pressure
• Diabetes and insulin resistance
• High cholesterol
• Smoking
• Obesity, particularly excess abdominal fat
• Chronic kidney disease
• Physical inactivity
• Long-term inflammation
• Increasing age

High blood pressure is particularly important.

When blood pressure remains elevated over many years, the arteries are exposed to greater mechanical stress. Over time, structural changes can occur within the arterial wall.

This creates a potentially important cycle: hypertension can contribute to arterial stiffening, while stiffer arteries can contribute to increased systolic blood pressure and pulse pressure.

This is one reason controlling blood pressure early matters.

Arterial stiffness is not the same as blocked arteries

This distinction is important.

Arterial stiffness and atherosclerosis are related but not identical.

Atherosclerosis involves the build-up of fatty plaques within artery walls. Arterial stiffness refers to reduced elasticity of the arterial wall.

A person can have arterial stiffness without having a severely blocked artery.

Conversely, someone can have significant atherosclerosis without having undergone a specific arterial stiffness assessment.

Both are important aspects of cardiovascular health, but they describe different processes.

Why does arterial stiffness matter for heart health?

Stiffer arteries can affect the way blood pressure and blood flow are transmitted through the cardiovascular system.

When large arteries become less able to cushion the pressure generated by each heartbeat, the heart and smaller blood vessels can be exposed to greater pulsatile stress.

Over time, increased arterial stiffness has been associated with a higher risk of cardiovascular events.

Research examining pulse wave velocity has found associations between higher arterial stiffness and cardiovascular events and mortality. [3]

The relationship is particularly relevant in people who already have cardiovascular risk factors such as hypertension, diabetes or kidney disease.

This does not mean that a high arterial stiffness measurement predicts that an individual will definitely have a heart attack or stroke.

It is better understood as one piece of information that can contribute to an overall assessment of cardiovascular risk.

5 Things Arterial Stiffness May Tell Us About Your Health

1. Your blood pressure may deserve closer attention

Arterial stiffness and hypertension are closely connected.

The 2024 ESC hypertension guidelines recognise arterial stiffness as a potential marker of hypertension-mediated organ damage and cardiovascular risk. [2]

This is particularly relevant for people with persistent high blood pressure.

If blood pressure has been elevated for many years, your doctor may need to consider not just the blood pressure reading itself but also whether there is evidence of effects on organs and blood vessels.

This may involve blood and urine tests, an ECG, imaging or other assessments depending on the individual situation.

2. Your cardiovascular risk may be higher than a routine check suggests

Traditional cardiovascular risk assessment usually considers factors such as:

• Age
• Blood pressure
• Cholesterol
• Smoking
• Diabetes
• Family history
• Existing cardiovascular disease

These remain fundamental.

In selected patients, however, additional information may help refine risk assessment.

The 2024 ESC guidelines note that pulse wave velocity can contribute to cardiovascular risk stratification, particularly when the treatment decision is uncertain after considering conventional risk factors. [2]

This is one reason arterial stiffness may sometimes be considered as part of a more detailed cardiovascular assessment.

3. Long-term hypertension may have affected your blood vessels

A person can have hypertension for years without feeling unwell.

This is one of the difficulties with high blood pressure. Symptoms are often absent, even while the condition is affecting the cardiovascular system.

HealthHub notes that hypertension can damage blood vessels and increase the risk of heart disease, kidney disease and stroke. [4]

Arterial stiffness can therefore be considered alongside other signs of hypertension-mediated organ damage.

For someone with difficult-to-control hypertension, early-onset hypertension or several cardiovascular risk factors, a broader assessment may be appropriate.

4. It may provide information beyond your blood pressure reading

Two people can have similar blood pressure readings but different overall cardiovascular risk.

Age, diabetes, cholesterol, kidney function, smoking history, family history and evidence of organ damage can all influence risk.

Arterial stiffness is one additional measure that may provide information about the condition of the large arteries.

However, it should not be viewed as a replacement for blood pressure measurement, cholesterol testing, diabetes screening or other established assessments.

A good cardiovascular evaluation looks at the whole picture.

5. It highlights the importance of protecting your arteries early

Perhaps the most useful message is that arterial health is something worth protecting throughout adult life.

You do not need to wait until an artery is severely damaged before taking cardiovascular risk seriously.

Managing blood pressure, avoiding smoking, maintaining a healthy weight, staying physically active, eating a balanced diet and controlling cholesterol and blood glucose where necessary are all important components of cardiovascular prevention.

Singapore’s Healthier SG screening programme includes assessment of cardiovascular risk factors such as obesity, high blood pressure, high cholesterol and diabetes for eligible individuals. [5]

How is arterial stiffness measured?

The most established method is pulse wave velocity.

During the assessment, sensors or specialised equipment are used to estimate how quickly the pressure wave travels through the arteries.

Carotid-femoral PWV is widely regarded as an established measure of large artery stiffness. The 2024 ESC guidelines also recognise carotid-femoral and brachial-ankle PWV as measures that may contribute to assessment in selected patients. [2]

A commonly referenced threshold for increased risk is a carotid-femoral PWV above 10 m/s, although interpretation should take into account the clinical context, measurement method and patient characteristics. [2]

It is important not to interpret a PWV number in isolation.

The result should be considered alongside blood pressure, age, cardiovascular risk factors and other clinical findings.

Can arterial stiffness be reversed?

This is a common and understandable question.

Some changes associated with arterial ageing may not be completely reversible. However, cardiovascular risk can still be reduced by addressing the factors that contribute to vascular damage.

The practical priorities include:

Control blood pressure

If you have hypertension, regular monitoring and appropriate treatment are important. Do not change prescribed medication without discussing it with your doctor.

Stay physically active

Singapore’s physical activity guidance recommends reducing sedentary behaviour and aiming for around 150 to 300 minutes of moderate-intensity aerobic activity each week for adults, where appropriate. [6]

Stop smoking

Smoking damages blood vessels and significantly increases cardiovascular risk.

Maintain a healthy weight

Excess abdominal fat is associated with several cardiovascular and metabolic risk factors.

Eat for cardiovascular health

Pay attention to salt, saturated fat, highly processed foods and overall portion sizes. A balanced dietary pattern can support blood pressure, cholesterol and metabolic health.

Manage diabetes and cholesterol

If you have diabetes, high cholesterol or other cardiovascular risk factors, appropriate monitoring and treatment are important.

Do you need an arterial stiffness test?

Not necessarily.

Arterial stiffness testing is not a routine requirement for everyone.

It may be considered in selected people when additional information about cardiovascular risk or hypertension-mediated organ damage could be clinically useful.

The 2024 ESC guidelines note that PWV is still used mainly in research settings or specialist referral centres, although it can have a role in selected clinical situations. [2]

If you have long-standing hypertension, difficult-to-control blood pressure, multiple cardiovascular risk factors or concerns about your overall cardiovascular health, it may be worth discussing with your doctor whether additional assessment is appropriate.

When should you see an internal medicine doctor in Singapore?

Many common cardiovascular risk factors can be managed effectively by a GP or family physician.

However, an internal medicine doctor in Singapore may be particularly useful when several medical problems occur together or when the underlying cause of abnormal findings is unclear.

For example, specialist assessment may be appropriate when someone has:

• Difficult-to-control hypertension
• Multiple cardiovascular risk factors
• Diabetes together with hypertension or kidney concerns
• Abnormal kidney function
• Unexplained changes in blood tests
• Early or unusual cardiovascular risk
• Several chronic conditions requiring coordinated assessment

Internal medicine takes a broad view of adult health. Rather than looking at blood pressure, cholesterol, kidney function or blood sugar as completely separate issues, the aim is to understand how these factors interact.

The bigger picture matters

Arterial stiffness is not a diagnosis that should cause unnecessary alarm.

It is better understood as an indicator of the health and function of the arterial system and, in selected patients, a useful additional piece of cardiovascular risk information.

For patients in Singapore, the most important step is not necessarily to have a specialised arterial stiffness test. It is to understand your overall cardiovascular risk and address the factors that can be changed.

If you have hypertension, diabetes, high cholesterol, kidney disease or several cardiovascular risk factors, discussing your overall risk with an internal medicine doctor in Singapore may help determine whether further assessment is appropriate.

The goal is not simply to measure how stiff your arteries are. It is to identify cardiovascular risk early and take sensible steps to protect your heart, brain, kidneys and blood vessels over the long term.

Medical disclaimer: This article is intended for general educational purposes and does not provide a diagnosis or personalised medical advice. Arterial stiffness measurements and cardiovascular risk should be interpreted by a qualified healthcare professional in the context of your medical history, examination and other test results.

1. What is arterial stiffness?

Arterial stiffness occurs when the walls of the arteries become less flexible and elastic. It is commonly assessed using pulse wave velocity, which measures how quickly a pressure wave travels through the arteries.

2. Is arterial stiffness the same as blocked arteries?

No. Arterial stiffness refers to reduced elasticity of the arterial wall, while blocked arteries are usually associated with atherosclerotic plaque that narrows or obstructs blood vessels. The two conditions are related to cardiovascular health but are not the same.

3. Does high blood pressure cause arterial stiffness?

Long-term high blood pressure can contribute to changes in the arterial walls and is associated with increased arterial stiffness. Arterial stiffness and hypertension can also influence one another.

4. Can arterial stiffness cause a heart attack?

Arterial stiffness itself does not mean that a heart attack will occur. However, higher arterial stiffness is associated with increased cardiovascular risk and should be considered alongside other risk factors.

5. How is arterial stiffness measured?

Pulse wave velocity is one of the established methods. Carotid-femoral pulse wave velocity is commonly used to assess large artery stiffness.

6. Is pulse wave velocity a routine health screening test?

Not for everyone. Current guidelines support its use selectively when additional information about cardiovascular risk or hypertension-mediated organ damage may be useful.

7. Can arterial stiffness be reduced?

Some age-related arterial changes cannot simply be reversed, but managing blood pressure, cholesterol, diabetes, smoking, weight, diet and physical activity can help reduce overall cardiovascular risk and support vascular health.

8. Can arterial stiffness occur without symptoms?

Yes. Arterial stiffness usually does not produce specific symptoms that a person can recognise. This is one reason cardiovascular risk assessment and appropriate health screening are important.

9. Should people with hypertension be tested for arterial stiffness?

Not everyone with hypertension needs the test. A doctor may consider it in selected patients when additional information could help assess cardiovascular risk or hypertension-mediated organ damage.

10. When should I see an internal medicine doctor in Singapore?

Consider discussing your health with an internal medicine doctor if you have difficult-to-control hypertension, several cardiovascular risk factors, multiple chronic conditions, abnormal test results or concerns that require a broader assessment of adult health.