From the Guidelines
Pulse pressure increases in conditions such as aging, exercise, anemia, hyperthyroidism, aortic regurgitation, and arterial stiffening due to atherosclerosis, with values greater than 60 mmHg potentially indicating cardiovascular disease risk, particularly in older adults. Pulse pressure is defined as the difference between systolic and diastolic blood pressure, typically ranging from 40 to 60 mmHg in healthy adults. It is a derived measure that combines the imperfections of the original measures, and its predictive value may vary with the clinical characteristics of the subjects 1.
Factors Influencing Pulse Pressure
- Aging: naturally causes arteries to lose elasticity, leading to increased systolic pressure and relatively unchanged or decreased diastolic pressure, thus widening the pulse pressure
- Exercise: increases cardiac output, raising systolic pressure more than diastolic pressure, and temporarily increasing pulse pressure
- Medical conditions: such as aortic regurgitation, which causes elevated pulse pressure due to blood flowing backward into the left ventricle during diastole, lowering diastolic pressure
- Arterial stiffness: from atherosclerosis prevents proper arterial expansion during systole, leading to higher systolic pressure and wider pulse pressure
Clinical Importance
Monitoring pulse pressure is crucial as persistently elevated values can indicate cardiovascular disease risk, particularly in older adults, and may require medical evaluation and management of underlying conditions 1. The predictive value of pulse pressure is strong in middle-aged and elderly hypertensive patients with cardiovascular risk factors or associated clinical conditions, but its contribution is small in individuals aged less than 55 years 1.
Key Considerations
- No practical cutoff values separating pulse pressure normality from abnormality at different ages have been produced, but values greater than 60 mmHg are considered potentially indicative of cardiovascular disease risk
- Central pulse pressure, which takes into account the ‘amplification phenomena’ between the peripheral arteries, is also an important consideration in assessing cardiovascular risk 1
From the Research
Definition of Pulse Pressure
- Pulse pressure is defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) 2, 3, 4, 5, 6.
- It is an indicator of large artery stiffness and has emerged as a new, potentially independent risk factor for cardiovascular disease 2.
When Pulse Pressure Increases
- Pulse pressure increases with age, as the walls of the aorta and large elastic arteries progressively harden due to senile degenerative phenomena and the loss of elasticity 4.
- It also increases in patients with isolated systolic hypertension, which is a disorder typically defined when the systolic BP is greater than 140 mm Hg but with diastolic BP below 90 mm Hg 5.
- An increased pulse pressure nearly always indicates reduced vascular compliance of large arteries 5.
- Pulse pressure is associated with several cardiovascular risk factors, including mean arterial pressure (MAP) 6.
Clinical Significance of Pulse Pressure
- Pulse pressure predicts events in epidemiologic studies, but elucidation of an independent role is hampered by the close correlation between pulse pressure and systolic blood pressure 2.
- High pulse pressure is an independent predictor of cardiovascular mortality, especially coronary mortality, in different populations 3.
- The clinical significance of pulse pressure should be considered not as an alternative to that of systolic and diastolic BP, but rather in complementary terms, with age kept in careful consideration 4.
- Pulse pressure is a useful metric for evaluating cardiovascular risk, particularly in older patients with hypertension 5.