Black Psychiatrists

In Reply: Dr Cheng notes that the Osler maneuver was not performed on the participants in our study. Pseudohypertension and the elevation in pulse pressure that occur with aging both reflect the underlying pathology of progressive arteriosclerosis and stiffening of the arteries with age. In fact, Messerli and colleagues¹ found that arterial compliance, as measured by pulse wave velocity and pressure decay index, was markedly increased in subjects who were Osler positive. Furthermore, in the Osler-positive patients, the systolic and diastolic pressures measured by sphygmomanometry were both about 16 mm Hg higher than the true intra-arterial pressure.¹ This resulted in falsely elevated mean arterial pressures but did not affect pulse pressure. Therefore, we would not anticipate that the importance of pulse pressure in our study would be altered by whether subjects were Osler positive or negative. Indeed, these observations would lend further support to the advantages of pulse pressure in providing additional useful prognostic information.