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Westerhof and colleagues have shown that the arterial pulse wave in large vessels is partly the consequence of forward pressure generated by the left ventricle and partly that due to a wave reflected from the periphery. As the large vessel loses elasticity, and the forward wave increases in speed, so the reflected wave returns earlier, impacting on the central pressure curve in systole rather than in early diastole. This augmentation in systole is, then, a consequence of vessel stiffness, being another way in which loss of elasticity and increase in vessel stiffness increases pulse pressure. I will return later to the question of why vessel stiffness might increase cardiovascular risk.