Introduction: Both arterial stiffness (AS) and capillary rarefaction are biomarkers of cardiovascular risk. We assessed whether capillary videomicroscopy may complement measurement of arterial stiffness in clinical assessment of cardiovascular risk. Subjects & Methods: We studied 94 out-patients with treated hypertension (age 63.9±1.5(SE)yrs, blood pressure (Omron) 147/87+2/1mmHg, 27F; hypercholesterolaemia 59, diabetes mellitus 23, chronic kidney disease 28, ischaemic heart disease 27, stroke syndromes 16, peripheral vascular disease 31). AS was estimated from aortic pulse wave velocity (PWV: Arteriograph, Unimedic); basal (BCD) and maximum skin capillary density (MCD) by videomicroscopy (KK Technology): abnormal AS PWV≥10 m/s, BCD ≤59 per 0.6mm2 field, MCD <66/field. Written informed consent was obtained for the studies, which were approved by the local research ethics committee. Results: Results were obtained both for PWV (11.1+0.2m/sec) and capillary density (BCD 53.4+1.5/ field; MCD 62.1+1.7/ field) in 70 patients (74%: 95%CI 65-83); for PWV alone (10.5+0.8 m/sec) in 8 patients (8%: 95% CI 3-13%); for capillary density alone (BCD 47.6+2.6/field; MCD 59.9+3.4/ field) in 10 patients (11%: 95% CI 5-17); and neither measurement in 6 patients (6%: 95%CI 1-11). Both PWV and capillary density were abnormal in 29 patients (41%: 95%CI 29-53). Capillary density was low but PWV normal in 22 (31%: 95%CI 20-42). PWV was raised but capillary density normal in 14 patients (20%: 95%CI 11-30); both readings were normal in 5 patients (7% 95%CI 1-13). PWV correlated positively with systolic (rs=0.457, p<0.001) and diastolic blood pressure (rs=0.265, P=0.021). Aortic augmentation index (Aix: 31.9+1.8%) also correlated significantly with systolic (rs=0.459, p<0.001) and diastolic blood pressure (rs=0.325, P=0.004). Basal capillary density correlated highly with maximum capillary density (rs=0.831, p<0.001). There was no significant correlation between PWV and BCD or MCD, before or after adjustment for history of ischaemic heart disease. Waist hip ratio was inversely related to MCD in patients without known ischaemic heart disease (n=57: rs -0.264, P=0.047). Conclusions: Large and small vessel readings were only concordant in 2 out of 5 patients in indicating increased cardiovascular risk. Capillary imaging identified a third of patients at increased cardiovascular risk not detected by PWV alone. Our findings support use of diagnostic tests for both micro- and macrocirculation when assessing clinical cardiovascular risk in patients with hypertension with or without cardiovascular co-morbidity.