With grade 1 diastolic dysfunction and a pulse pressure of about 59 mm Hg (systolic ≈124 mm Hg, diastolic ≈65 mm Hg) and no confirmed heart failure with preserved ejection fraction, what does this pulse pressure indicate about arterial compliance and the likelihood of heart failure?

Pulse Pressure Interpretation in Grade 1 Diastolic Dysfunction

Your pulse pressure of 59 mm Hg is actually normal and does not suggest heart failure—in fact, it indicates relatively preserved arterial compliance and argues against significant cardiovascular pathology at this time. 1

Understanding Your Pulse Pressure

You are correct that narrowed pulse pressure (typically <40 mm Hg) can be associated with heart failure, but your situation is the opposite:

• Your PP of 59 mm Hg falls in the normal-to-favorable range 1
• In dialysis patients (where PP has been most extensively studied as a mortality marker), PP ≤59 mm Hg was associated with the lowest mortality rate of 28%, compared to 38% for PP 60-79 mm Hg, 46% for PP 80-99 mm Hg, and 60% for PP ≥100 mm Hg 1
• Wide pulse pressure (>60-80 mm Hg), not narrow PP, is the concerning finding that reflects arterial stiffness and increased cardiovascular risk 1

What Your PP Indicates About Arterial Compliance

Pulse pressure reflects the difference between systolic and diastolic blood pressure and serves as a surrogate marker for arterial stiffness and compliance 1:

• Your PP suggests relatively preserved arterial elasticity 1
• Wide PP indicates stiff arteries that increase left ventricular afterload and decrease coronary perfusion during diastole 1
• Arterial stiffness is particularly relevant in HFpEF because aging decreases elastic properties of the heart and great vessels, leading to increased systolic blood pressure and myocardial stiffness 1

Grade 1 Diastolic Dysfunction Context

Grade 1 diastolic dysfunction represents the mildest form of diastolic impairment and does not equate to HFpEF 2:

• Stage I diastolic dysfunction is characterized by reduced LV filling in early diastole but with normal LV and left atrial pressures and normal compliance 2
• This is fundamentally different from HFpEF, which requires symptoms/signs of heart failure plus elevated filling pressures 3, 4
• Your normal PP further supports that you do not have the arterial stiffness and elevated afterload commonly seen in symptomatic HFpEF patients 1

Likelihood of Heart Failure

Your clinical picture argues strongly against current HFpEF:

• HFpEF diagnosis requires: (1) typical HF symptoms (breathlessness, fatigue, ankle swelling), (2) signs of HF (tachycardia, pulmonary rales, elevated JVP, peripheral edema), (3) preserved LVEF ≥40-50%, and (4) evidence of diastolic dysfunction with elevated natriuretic peptides 3, 4
• Grade 1 diastolic dysfunction alone, without symptoms or elevated filling pressures, does not meet HFpEF criteria 2, 4
• Your normal PP suggests you lack the arterial stiffness and reduced vascular compliance that play important pathophysiologic roles in many HFpEF patients 1

What to Discuss at Your Cardiovascular Center Visit

Focus your evaluation on:

• Comprehensive assessment of diastolic function parameters beyond grade classification, including tissue Doppler velocities (e' velocity), left atrial volume index, and tricuspid regurgitation velocity 5, 6
• Exercise stress echocardiography may be valuable if there is diagnostic uncertainty, as LV longitudinal strain and diastolic relaxation during exercise can unmask dysfunction not apparent at rest 6
• Natriuretic peptide levels (BNP or NT-proBNP) to assess for elevated filling pressures 4
• Evaluation for common comorbidities that contribute to diastolic dysfunction: hypertension control, diabetes management, coronary artery disease screening 1, 3

Common Pitfall to Avoid

Do not conflate diastolic dysfunction with diastolic heart failure—they are not synonymous 3:

• Approximately 20-60% of patients with heart failure have preserved systolic function, but many more patients have diastolic dysfunction without heart failure 3
• Pure diastolic heart failure requires evidence of abnormal diastolic function causing symptoms, not just echocardiographic findings 3
• Your normal pulse pressure and Grade 1 dysfunction suggest you are in an early, asymptomatic phase that warrants monitoring but not HF treatment 2

Risk Factor Management

Even without HFpEF, controlling modifiable risk factors is essential 1, 3:

• Strict blood pressure control (both systolic and diastolic hypertension) is the cornerstone of preventing progression 1, 3
• Your current BP (124/65 mm Hg) appears well-controlled, which is favorable 1
• Maintain this control, as aging has greater impact on diastolic function than systolic function, and arterial stiffness increases with age 1