Stroke can be related to high central systolic pressure due to aortic stiffness or the diastolic pressure too low in patients with stiff aorta. Diastolic cannot be measured by cuff in middle aged and older hypertensives. There are only two reliable references in the literature, which I can provide when I get to my office. There is only one way to measure true DP in these patients, invasively; but there are ways to find out who these patients are: by the pressure waveform (Pauca et al. B J of Anaesth 2004). The radial pressure waveform shows that the SP is produced by the second peak instead of the first
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However, the DP can be read by cuff in older normotensive subjects and it can reach 40 mmHg with a SP of 100-120, produced by P1. If you look at the pressure wave, you will see that P2 is much lower than P1.
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