Relation of Pulse Pressure and Blood Pressure Reduction to the Incidence of Myocardial Infarction

To the editor I was extremely interested in the article by Madhavan et al "Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction " (Hypertension. 1994;23:395-401.), and I have personally no doubt as to the relevance of the data. However, I should like to comment on two points: the first one on the J-shaped curve, and the second one on the predictive value of body size on the risk of myocardial infarction. Because of the propagation of a pressure wave along the arterial tree and to the summation between incident and reflected pres-sure waves, pulse pressure is physiologically higher in peripheral than in central arteries for the same mean arterial pressure.1 Thus, it is difficult to extrapolate coronary systolic, diastolic, and pulse pressures from brachial pressure measurements. Particularly in younger subjects, systolic blood pressure is expected to be lowe