Arterial stiffness The term “arterial stiffness” once referred only to the loss of compliance in the large arteries, now it is a comprehensive term encompassing the characteristics of the entire arterial system, including the biochemical-structural-mechanical changes in the small and large arteries, as well as the comparative pressures. Cardiovascular disease is the No. 1 cause of death worldwide. Heart attack, heart failure and stroke are the top three within the category. A sudden jump in blood pressure is the most frequent cause of stroke, while myocardial infarctions (heart attacks) are most often caused by a partial or full coronary occlusion, a rupture of vulnerable plaque built up during severe coronary atherosclerosis. In nearly every case, some stage of the process of sclerosis is present. In order to prevent severe vascular crises, it is essential to identify individuals who are at risk but have not yet developed symptoms. Identification of at-risk individuals, examination of the patient for the signs of preclinical atherosclerosis, as well as the identification and treatment of the classical risk factors are included in the European Guidelines for the management of arterial hypertension since 2007. “Sudden heart attack,” in the literal sense of the word, does not exist. The arterial system prepares for a plaque rupture over the course of years, or even decades, like a ticking time bomb. Most severe events can, therefore, be prevented with early detection of atherosclerosis (with the help of functional and structural tests) and preventive treatment begun in a timely manner. European Guidelines list the types of target organ damage that can occur even in asymptomatic patients. The screening is recommended and mandatory in every hypertension patient. The Guidelines emphasize the screening for asymptomatic atherosclerosis in as large a pool of individuals as possible, as well as the importance of such testing for high risk of cardiovascular disease because together with the traditional risk factors, it has a greater degree of predictive value. It is a simple, proven fact today that arterial stiffness is a truly important and independent indicator of cardiovascular risk. The functional and structural changes in the large arteries are partly age-related, but there are several conditions that show a link with accelerated arterial stiffening, such as hypertension, atherosclerosis, end-stage renal disease, as well as the traditional risk factors (diabetes, dyslipidemia, smoking etc.). That is why arterial stiffness has become a main topic of clinical research in recent years, indicated by the huge increase in publications on the subject.