BACKGROUND: Endothelial function and arterial stiffness are known to be altered in pre-eclamptic pregnancies. Previous studies have shown conflicting results regarding the best technique for assessing vascular function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function (including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness) in pre-eclamptic patients and compared them to normal pregnancies. In addition, we assessed the relation between vascular function and systemic inflammation. METHODS: Fourteen patients with pre-eclampsia (PE) and 14 healthy pregnant controls were included. Endothelial function was determined by FMD and PAT, arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx). Systemic inflammation was assessed using mean platelet volume (MPV) and neutrophil-leucocyte ratio (NLR). RESULTS: The reactive hyperemia index (RHI), assessed using PAT is decreased at the third trimester in comparison to the first trimester in a normal uncomplicated pregnancy (p=0.001). Arterial stiffness is significantly higher in PE versus normal pregnancy (p<0.001). Endothelial function obtained by FMD is deteriorated in PE versus normal pregnancy (p=0.015), while endothelial function assessment by PAT is improved in PE versus normal pregnancy (p=0.001). Systemic inflammation (MPV, NLR) increases during normal pregnancy. CONCLUSIONS: Flow mediated dilation and peripheral arterial tonometry are disturbed in pre-eclampsia. Endothelial function assessed by FMD and PAT show distinct results. This may indicate that measurements with FMD and PAT reflect different aspects of endothelial function and that PAT should not be used as a substitute for FMD as measure of endothelial function in pregnancy.