From the Guidelines
Wide pulse pressure is most commonly caused by aortic regurgitation, arterial stiffness due to aging or atherosclerosis, and other conditions that increase stroke volume or reduce diastolic blood pressure. The difference between systolic and diastolic blood pressure exceeding 40 mmHg can be caused by several conditions, including hyperthyroidism, anemia, high-output states like fever, pregnancy, or arteriovenous fistulas, patent ductus arteriosus, severe aortic stenosis with left ventricular failure, and conditions that increase stroke volume such as exercise or anxiety 1. Certain medications like vasodilators, beta-blockers, and calcium channel blockers can also affect pulse pressure.
Causes of Wide Pulse Pressure
- Aortic regurgitation: where the aortic valve doesn't close properly, allowing blood to flow back into the left ventricle 1
- Arterial stiffness: due to aging or atherosclerosis, which increases systolic blood pressure and decreases diastolic blood pressure 1
- Hyperthyroidism: which increases cardiac output and can lead to wide pulse pressure
- Anemia: which reduces blood viscosity and can lead to wide pulse pressure
- High-output states: like fever, pregnancy, or arteriovenous fistulas, which increase cardiac output and can lead to wide pulse pressure
Clinical Importance
Wide pulse pressure is clinically important as it can indicate cardiovascular disease and is associated with increased risk of heart failure, stroke, and mortality 1. Management focuses on treating the underlying cause, which may include medication adjustments, valve repair or replacement for valvular issues, or lifestyle modifications to address atherosclerosis and hypertension. According to the 2020 ACC/AHA guideline for the management of patients with valvular heart disease, severe aortic regurgitation is associated with a wide pulse pressure, and treatment with vasodilating drugs such as ACE inhibitors or ARBs may reduce systolic blood pressure without a substantial reduction in diastolic blood pressure 1.
From the Research
Causes of Wide Pulse Pressure
- Wide pulse pressure can be caused by various factors, including arteriosclerosis and diffuse vascular stiffening, which occur naturally as individuals age 2
- Hyperdynamic circulation and high-output heart failure can also lead to wide pulse pressure, with conditions such as aortic regurgitation and hyperthyroidism being potential causes 2
- Aortic regurgitation, a valvular disease characterized by retrograde blood flow from the aorta to the left ventricle, can result in wide pulse pressure due to the increased volume of blood in the left ventricle 3, 4, 5
Underlying Conditions
- Aortic regurgitation can be acute or chronic, with acute AR being a medical emergency and chronic AR progressing gradually, leading to heart failure symptoms due to left ventricular remodeling 3, 4
- Other conditions, such as abdominal aortic aneurysms, may also be related to wide pulse pressure, with the renin-angiotensin system playing a pivotal role in their pathogenesis 6
Treatment and Management
- Treatment of wide pulse pressure often focuses on controlling hypertension and delaying left ventricular dysfunction, with medications such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium-channel blockers being recommended 3, 4
- Pulse pressure control can be achieved with thiazide diuretics and long-acting nitrates, although further research is needed to quantify the additional benefits of pulse pressure control over conventional blood pressure therapy 2