A longitudinal study of the Framingham Heart Study Offspring cohort found that higher aortic stiffness, forward wave amplitude (FWA), and augmentation index were associated with an increased risk of incident hypertension. However, initial blood pressure was not independently associated with progressive aortic stiffening. The study examined the temporal relationships between vascular stiffness, central hemodynamics, microvascular function, and blood pressure progression over a 7-year period in 1759 participants. Results showed that higher FWA and CFPWV during examination cycle 7 were jointly associated with higher systolic blood pressure during examination cycle 8. Additionally, higher FWA, augmentation index, and CFPWV during examination cycle 7 were associated with incident hypertension during examination cycle 8. Conversely, blood pressure during examination cycle 7 was not associated with CFPWV during examination cycle 8. Higher resting brachial artery flow and lower flow-mediated dilation during examination cycle 7 were also associated with incident hypertension. The study suggests that vascular stiffness, central pressure pulsatility, and peripheral wave reflection may antedate and contribute to the development of hypertension. The findings support the notion that vascular stiffness is a precursor rather than the result of hypertension. The study also highlights the importance of endothelial function and microvascular resistance in the development of hypertension. Limitations include the observational nature of the study and potential underestimation of relationships due to antihypertensive treatment. The study underscores the need for interventions targeting vascular stiffness to prevent incident hypertension.A longitudinal study of the Framingham Heart Study Offspring cohort found that higher aortic stiffness, forward wave amplitude (FWA), and augmentation index were associated with an increased risk of incident hypertension. However, initial blood pressure was not independently associated with progressive aortic stiffening. The study examined the temporal relationships between vascular stiffness, central hemodynamics, microvascular function, and blood pressure progression over a 7-year period in 1759 participants. Results showed that higher FWA and CFPWV during examination cycle 7 were jointly associated with higher systolic blood pressure during examination cycle 8. Additionally, higher FWA, augmentation index, and CFPWV during examination cycle 7 were associated with incident hypertension during examination cycle 8. Conversely, blood pressure during examination cycle 7 was not associated with CFPWV during examination cycle 8. Higher resting brachial artery flow and lower flow-mediated dilation during examination cycle 7 were also associated with incident hypertension. The study suggests that vascular stiffness, central pressure pulsatility, and peripheral wave reflection may antedate and contribute to the development of hypertension. The findings support the notion that vascular stiffness is a precursor rather than the result of hypertension. The study also highlights the importance of endothelial function and microvascular resistance in the development of hypertension. Limitations include the observational nature of the study and potential underestimation of relationships due to antihypertensive treatment. The study underscores the need for interventions targeting vascular stiffness to prevent incident hypertension.