From the Guidelines
A pulse pressure of more than 40 mmHg is not necessarily abnormal, but a pulse pressure above 60 mmHg is more concerning and may indicate underlying cardiovascular issues. The average normal pulse pressure is typically between 40-60 mmHg 1. A wide pulse pressure has been shown in some studies to be a better predictor of adverse cardiovascular outcomes than either systolic or diastolic blood pressure individually, and to identify patients with systolic hypertension who are at particularly high risk 1. However, the largest meta-analysis of observational data from 61 studies found that pulse pressure was less predictive than both systolic and diastolic blood pressure 1.
Key points to consider when evaluating pulse pressure include:
- A pulse pressure above 60 mmHg may suggest conditions like aortic regurgitation, hyperthyroidism, anemia, or arterial stiffening due to aging or atherosclerosis
- A very narrow pulse pressure (less than 25 mmHg) might indicate heart failure or shock
- Blood pressure should be interpreted in context with other vital signs and symptoms
- If you consistently have a wide pulse pressure, especially above 60 mmHg, it's advisable to consult with a healthcare provider for proper evaluation, particularly if you have other cardiovascular risk factors or symptoms 1.
The reason for concern with wide pulse pressures is that they can place additional stress on the heart and blood vessels over time, potentially contributing to cardiovascular complications. It's essential to consider the overall cardiovascular risk profile of an individual when evaluating pulse pressure, as the threshold for hypertension and the need for drug treatment should be considered flexible based on the level and profile of total cardiovascular risk 1.
From the Research
Pulse Pressure and Cardiovascular Risk
- Pulse pressure is the difference between systolic and diastolic blood pressure, and it has been recognized as an independent factor of cardiovascular risk 2.
- An increased pulse pressure nearly always indicates reduced vascular compliance of large arteries, and it is always increased in patients with isolated systolic hypertension 2.
- A study found that for men aged 60 years or older, those in the highest versus lowest quartiles of average pulse pressure (≥55 versus <44 mm Hg) had a relative risk of cardiovascular disease of 1.83 3.
Definition of Abnormal Pulse Pressure
- There is no clear definition of an abnormal pulse pressure in the provided studies, but a pulse pressure of more than 40 mmHg is not explicitly mentioned as a threshold for abnormality.
- However, a study found that a pulse pressure of ≥55 mm Hg was associated with an increased risk of cardiovascular disease in men aged 60 years or older 3.
Relationship Between Pulse Pressure and Cardiovascular Outcomes
- The relationship between pulse pressure and cardiovascular outcomes is complex, and it is influenced by various factors such as age, systolic blood pressure, and diastolic blood pressure 4, 3, 5.
- A study found that both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg) 5.