It is expected that sustained high blood pressure, as seen in hypertension, would cause vascular damage by, for instance, altering the collagen–elastin ratio of the arterial wall in favour of collagen.28,29 Indeed, after adjustment for mean arterial pressure, the difference in carotid distensibility between the hypertensives and normotensives remained, therefore suggesting the presence of structural alterations. Here, ELN is linked to blood pressure trait.