Figure 32-16 Impact of pressure wave reflection on arterial pressure waveforms. In elderly individuals with reduced arterial distensibility, early return of reflected waves increases pulse pressure, produces a late systolic pressure peak (arrow), and attenuates the diastolic pressure wave. Myocardial oxygen balance is more tenuous in the elderly because these changes in blood pressure increase myocardial oxygen demand during systole and reduce myocardial oxygen supply during diastole.