Revisiting the Windkessel Function: Toward Accessible Assessment of Central Arterial Health

Cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for nearly one-third of global mortality. Arterial stiffening, particularly in the central elastic arteries, impairs the Windkessel (cushioning and pumping) function and contributes to cardiovascular risk beyond traditional factors. Carotid-femoral pulse wave velocity (cfPWV) is established as the gold standard for assessing aortic stiffness and predicting cardiovascular and all-cause mortality; however, its technical complexity and requirement for trained personnel limit its use in routine clinical and community settings. These challenges have driven the development of simplified techniques for population screening, such as brachial-ankle PWV (baPWV). More recently, single-cuff oscillometric devices have emerged as practical alternatives. These methods are simple enough to be implemented in daily healthcare at home, thereby greatly enhancing accessibility, although their accuracy depends on model assumptions and calibration. In this perspective article, we highlight the pathophysiological significance of preserving the central arterial Windkessel function and emphasize the need for its practical assessment. Recent innovations mark a paradigm shift from complex laboratory-based measurements toward simplified, data-driven, and socially feasible screening tools for the early detection and prevention of CVD.