From the Guidelines
A wide pulse pressure, as seen in a blood pressure of 110/40 mmHg, is most likely caused by aortic regurgitation, which is associated with a wide pulse pressure due to the increased stroke volume and decreased diastolic pressure. This condition is characterized by the aortic valve failing to close properly, allowing blood to flow back into the left ventricle during diastole, thereby lowering diastolic pressure 1. Other significant causes of a wide pulse pressure include:
- Arterial stiffness from aging or atherosclerosis
- Patent ductus arteriosus
- Severe anemia
- Hyperthyroidism
- Fever
- Conditions that increase cardiac output, such as exercise, pregnancy, and anxiety
- Certain medications, such as vasodilators, beta-blockers, and calcium channel blockers
- Severe sepsis, which can cause vasodilation leading to decreased diastolic pressure
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 the diagnosis can be confirmed by Doppler echocardiography 1. The guideline also recommends that patients with severe aortic regurgitation undergo further cardiac evaluation, including echocardiography, to guide appropriate treatment.
It is essential to note that a wide pulse pressure can be clinically significant, as it may indicate underlying cardiovascular pathology and is associated with an increased risk of heart failure, stroke, and kidney disease 1. Therefore, when encountering a wide pulse pressure, it is crucial to conduct a thorough evaluation, including a physical examination and laboratory tests, to identify the specific cause and guide appropriate treatment.
In the context of real-life clinical medicine, it is essential to prioritize the patient's morbidity, mortality, and quality of life when managing a wide pulse pressure. This may involve referring the patient to a cardiologist for further evaluation and treatment, as well as implementing lifestyle modifications and medications to manage any underlying conditions that may be contributing to the wide pulse pressure.
From the Research
Causes of Wide Pulse Pressure
A wide pulse pressure, as seen in a blood pressure of 110/40 mmHg, can be caused by several factors, including:
- Hyperdynamic circulation and high-output heart failure, such as aortic regurgitation and hyperthyroidism 2
- Arteriosclerosis and diffuse vascular stiffening, which naturally increase pulse pressure over time as individuals age 2
- Other conditions that affect the cardiovascular system, such as severe aortic stenosis and left ventricular systolic dysfunction 3
Pathogenesis and Treatment
The pathogenesis of wide pulse pressure is complex and involves various mechanisms, including:
- Increased systolic blood pressure and decreased diastolic blood pressure, resulting in a wide pulse pressure 2
- Vasodilators, such as nitroprusside, may improve myocardial performance in patients with severe aortic stenosis and left ventricular systolic dysfunction, but should be used with caution due to potential toxicity 3, 4
- Antihypertensive treatment with calcium channel blockers may be associated with an adverse effect on treadmill exercise and reduced survival in asymptomatic patients with moderate or severe aortic stenosis 5
Management of Hypertensive Crises
In cases of hypertensive crises, including urgencies and emergencies, the management approach depends on the underlying causes, patient demographics, cardiovascular risk, and comorbidities 4, 6. The goal is to reduce blood pressure gradually, avoiding aggressive lowering, and to control chronic blood pressure values 6.