Hypertension is accompanied by generalized adverse vascular functional and structural changes including increased large central artery stiffness. Aortic pulse wave velocity (PWV) is a measure of regional large artery stiffness regarded as the gold standard by expert consensus. Elevated aortic PWV imposes additional left ventricular (LV) workload through increased impedance to flow, and independently correlates with LV systolic and diastolic function, as well as cardiovascular mortality. Traditional antihypertensive drugs do not specifically target wall stiffness of the central arteries, but nonetheless may achieve a decline in aortic PWV by reducing mean arterial pressure and unloading the vessel wall. Beyond medication, regular aerobic exercise combined with sodium restricted diet (such as that advocated by the Dietary Approach to Stop Hypertension [DASH] diet) is probably the most effective way to counteract increased large central artery stiffness. This paper reviews the assessment and clinical implications of arterial stiffness in managing patients with hypertension.