<International Circulation>:Dr. Barkis， for patients with renal and cardiovascular consequences of chronic renal disease， what are your thoughts about using pulse wave velocity?

      Prof.Bakris:So pulse wave velocity is an excellent tool to look at the vessels in people with advanced kidney disease who are more prone to have stiff vessels and calcified vessels. Is it a ready for primetime guide that you should shoot for adjusting now? It’s still a research tool. As we know that people with increased pulse wave velocities have greater stiffness and probably don’t do as well in terms of cardiovascular outcomes so it is a marker of risk. But we don’t know at this point， there’s no evidence that any specific drug significantly modifies that. And there’s no evidence that that in a vacuum， if you will， is giving you independent risk from just blood pressure itself. So right now it’s a measure of stiffness and it’s looking at pliability of the vessels. We know that people with stiff vessels have higher cardiovascular risk. We know lowering blood pressure reduces cardiovascular risk， and now the question is can we remodel the vessels to get them to look better. We don’t know that yet.

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