In the last few years increasing attention has been given to investigate the role of large arteries in the pathophysiology of arterial hypertension and cardiovascular diseases. Thanks to their elastic properties, these vessels convert pulsatile flow in continuous flow at capillary level, thus significantly affecting the tissue perfusion. Various factors can modify the elastic properties of large arteries (arterial-wall structure alteration, vasoactive substances, elevated transmural pressure) and thus have positive or negative effect on cardiac function, vascular damage and systemic circulation. New ultrasonic techniques allow one to evaluate these vascular properties and to detect early changes in vessel structure and function. These techniques appear to be a promising tool to provide early markers of hypertensive vascular disease and of vascular risk in general, as well as to follow the vascular effects of treatment.