In Reply We agree with Dr Anstadt about the tetrad linking systolic and diastolic blood pressure and that pulse pressure is a critically important consideration in any analysis of the relationship between blood pressure and CVD outcomes. Pulse pressure adds prognostic information to systolic or diastolic blood pressure values because pulse pressure, which is calculated as the absolute difference between systolic and diastolic blood pressure, is related to both stroke volume and the compliance of large arteries (with the latter influencing vascular resistance). Therefore, pulse pressure can be an important surrogate marker for the health of large arteries. Indeed, our group has published related studies from the Atherosclerosis Risk in Communities (ARIC) Study that highlight the importance of pulse pressure in analyses of diastolic blood pressure in particular.1
McEvoy JW, Selvin E. Pulse Pressure and Isolated Diastolic Hypertension—Reply. JAMA. 2020;323(23):2431–2432. doi:10.1001/jama.2020.5937
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