From the Guidelines
Widened pulse pressure is a strong indicator of increased arterial stiffness, which can lead to adverse consequences such as isolated systolic hypertension, increased cardiac work, and organ damage 1.
Key Points
- A widened pulse pressure is associated with decreased compliance of arteries, resulting from thinning, fragmentation, and fracture of elastin fibers, as well as increased collagen deposition 1.
- Arterial stiffness leads to increased pulse wave velocity and reflection, resulting in augmentation of central systolic blood pressure and decreased diastolic blood pressure 1.
- Increased arterial stiffness is a key biomarker of vascular health, predicting cardiovascular mortality and morbidity above and beyond conventional cardiovascular risk factors 1.
- Pulse pressure can be used as a surrogate for pulse wave velocity, with increased pulse pressure associated with increased all-cause mortality in certain patient populations 1.
- In clinical practice, pulse pressure may be used to identify elderly patients with systolic hypertension who are at a particularly high risk of advanced organ damage 1.
Clinical Implications
- Monitoring pulse pressure can help identify patients at risk of cardiovascular disease and guide treatment decisions.
- Reducing arterial stiffness through lifestyle modifications or pharmacological interventions may help improve cardiovascular outcomes.
- Assessing pulse pressure can provide valuable information on arterial stiffness and vascular health, particularly in elderly patients with systolic hypertension.
From the Research
Indications of Widened Pulse Pressure
- A widened pulse pressure is associated with cardiovascular risk factors such as diabetes, hypertension, and smoking 2
- It predicts a higher risk of subsequent cardiovascular events, stroke, renal disease, heart failure, and mortality, particularly in the elderly 2
- Wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risk for mortality, disease progression, and adverse clinical outcomes in chronic diseases including cardiovascular disease and chronic kidney disease 3
- An increase in pulse pressure is a marker of altered conductance, and when the stroke volume is normal, it is a marker of altered conductance arteries 4
- Wider pulse pressure predicts cardiovascular mortality independently of traditional risk factors, left ventricular hypertrophy, and reduced ejection fraction 5
Underlying Causes
- Age-related stiffening of the central elastic arteries and systolic hypertension 2
- Arteriosclerosis and diffuse vascular stiffening 3
- Hyperdynamic circulation and high-output heart failure, such as aortic regurgitation and hyperthyroidism 3
- Loss of elasticity of conductance arteries 4
Clinical Implications
- Pulse pressure provides information beyond systolic and diastolic blood pressures, from which it is calculated 2
- Current emphasis of antihypertensive treatment on systolic and diastolic blood pressure does not always address pulse pressure, thus subjecting many patients to an independent risk factor for poor outcomes 3
- Pulse pressure control is more successfully achieved with thiazide diuretics and long-acting nitrates when compared to other antihypertensive agents 3