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Figure 2 Schematic diagram illustrating the concept of bidirectionality in the relationship between pulse pressure (PP) and atherosclerosis. Elevated PP promotes vascular damage, an antecedent to atherosclerosis, which results in large-vessel stiffening and increased wave reflection, thus, further amplifying PP. While it is not clear which is the incipient event in this cycle, it is clear that, once initiated, a vicious cycle promoting disease progression ensues.