Arterial stiffness as a marker of subclinical target organ damage in patients with arterial hypertension (AH) is an important and independent predictor of mortality and cardiovascular morbidity. The review examines factors that contribute to increased vascular wall stiffness with a focus on smoking, mechanisms of increased arterial stiffness with aging, and the effect of arterial stiffness on increased systolic and pulse blood pressure (BP). Particular attention is paid to the effect of pulse blood pressure on the risk of cardiovascular complications, primarily on the incidence of stroke and cognitive impairment.