Abstract-Stiffness of large elastic arteries is elevated in subjects with hypertension, an effect that could potentially be explained by increased distending pressure. We examined effects of an acute change in blood pressure on carotid-femoral pulse wave velocity and carotid artery distensibility (inversely related to stiffness) in normotensive control subjects (nϭ20, mean age 42) with mean arterial pressure (MAP) 84Ϯ1.7 mm Hg (meanϮSE) and subjects with essential hypertension (nϭ20, mean age 45, MAP 104Ϯ2.0 mm Hg). Normotensive subjects received intravenous nitroglycerin (NTG) and angiotensin II to lower/increase blood pressure. Hypertensive subjects received NTG to lower blood pressure. Pulse wave velocity was 24% (95% CI: 12% to 35%) higher and carotid distensibility 47% (95% CI: 32% to 63%) lower in hypertensive subjects compared with controls. In normotensive subjects, acute changes in blood pressure produced expected changes in stiffness. However, in hypertensive subjects, despite reducing MAP by 22 mm Hg to the same level as in normotensive subjects, there was no detectable reduction in arterial stiffness: pulse wave velocity remained 24% (95% CI: 10% to 38%) higher and carotid distensibility 48% (95% CI: 31% to 63%) lower in hypertensive compared with normotensive subjects. Because blood pressure-independent effects of NTG are, if anything, to reduce stiffness, these results indicate that elevated carotid and aortic stiffness in hypertensive subjects is not explained by elevated blood pressure but relates to structural change in the arterial wall. Key Words: arterial pressure Ⅲ carotid arteries Ⅲ hypertension, arterial C arotid-femoral pulse wave velocity (PWV), a measure of the functional stiffness of large elastic arteries, is increased in hypertensive subjects 1,2 and, in such subjects, 3-5 as well as in other groups at high cardiovascular risk 6,7 and in older subjects in the general population, 8 predicts future cardiovascular events. Arterial stiffness is determined both by the structure of the arterial wall and by the loading conditions on the wall, particularly mean distending pressure, which is closely related to mean arterial pressure (MAP). 9,10 An acute elevation of blood pressure results in increased arterial stiffness in both animal models and in human subjects. 9,11,12 However, in hypertensive subjects it is not clear whether increased stiffness occurs as a result of elevated blood pressure or whether there is an intrinsic change in the elasticity of the arterial wall so that, when compared at the same operating pressure, it is stiffer than that in normotensive subjects. Previous studies to address this issue have examined the relationship of arterial pressure to diameter of the common carotid artery throughout the cardiac cycle with extrapolation to a common pressure. This approach suggests that, when compared at the same operating pressure, stiffness of the common carotid artery is similar in hypertensive and in normotensive subjects 13-15 but makes assumptions regarding the form of the ...