The association in adults of increased arterial stiffness and various pathophysiological conditions, which are themselves also associated with increased cardiovascular risk, has been extensively reviewed. Studies have also shown that arterial stiffness is associated with end-organ alterations including left ventricular hypertrophy and arterial intima-media thickening in adults independent of systemic blood pressure. Importantly, stiffness of central arteries, as assessed by aortic pulse wave velocity and carotid distensibility, has been shown to have independent predictive value for cardiovascular events in the general adult population, in the elderly, in adults with hypertension, in end-stage renal failure, and with impaired glucose tolerance. While central arterial stiffness has been the focus of most of the adult studies, the contribution of stiffness of the smaller peripheral arteries to total vascular impedance should not be ignored. Structural remodeling occurs also in smaller arteries and branching points. The changes in mechanical properties of conduit and resistive arteries influence wave reflections and contribute to augmentation of late systolic blood pressure in the aortic root. Hence, carotid augmentation index has also been shown to have independent predictive value for cardiovascular events in adults with hypertension, and end-stage renal failure and in those undergoing percutaneous coronary interventions. Associations between increased small artery stiffness, as assessed by pulse contour analysis, and aging, hypertension, smoking, diabetes, and cardiovascular events have also been reported.