Role of arterial stiffness and central hemodynamics in personalized medicine in hypertension

To achieve optimal health and medical outcomes, personalized medicine has been proposed to exploit diagnostic and screening methods that utilize the knowledge of the patient's unique personal profile obtained in healthcare for improving the treatment or prevention of disease. Hypertension is the most common modifiable risk factor for vascular disease and the leading cause of morbidity and mortality across the globe. Increased arterial stiffness and adverse central pulsatile hemodynamics can be the cause and consequence of hypertension and its complications. In this chapter, we attempt to introduce the utility of arterial stiffness and central pulsatile hemodynamic indices for individualizing approaches in the diagnosis and management of hypertension. We will discuss available evidence regarding how arterial stiffness and central pulsatile hemodynamics relate to hypertension phenotypes and how measuring these mechanical biomarkers may personalize antihypertensive therapy. Several phenotypes, such as isolated systolic hypertension, isolated diastolic hypertension, isolated central hypertension, isolated brachial hypertension, white coat hypertension, masked hypertension, isolated nocturnal hypertension, and exaggerated blood pressure variability, are covered in this chapter. Characterizing individual-specific vascular properties as biomechanical markers in the detection, evaluation, treatment, and prevention of hypertension is at its infancy stage, but the ideal personalized medicine could finally be achieved by the relentless efforts toward this “holy grail.”