Introduction
As we age, our bodies undergo various physiological changes, including changes in cardiovascular function. Among the measures used to assess cardiovascular health, pulse pressure is an important indicator. In this article, we look at the relationship between pulse pressure and ageing and discuss factors that contribute to changes in pulse pressure with age, as well as strategies that can help you improve and maintain cardiovascular health.
When measuring blood pressure at the doctor's or at home, we obtain two values, the systolic and the diastolic blood pressure. While these provide valuable insights into heart health, another measure, known as pulse pressure, is also important in assessing cardiovascular function: Pulse pressure reflects the force exerted on the arterial walls with each heartbeat and can provide important information about your health.1,2
Systolic and diastolic blood pressure
Before looking at pulse pressure, it is important to understand the basics of blood pressure measurement. Blood pressure is usually expressed as two numbers: systolic pressure and diastolic pressure. Systolic pressure represents the force exerted against the aorta when the heart contracts and ejects blood into the aorta, while diastolic pressure is the minimum pressure experienced in the aorta and measures the force when the heart is at rest between beats.1
Blood pressure categories
According to the American Heart Association, blood pressure levels are categorised as follows, with high blood pressure known as hypertension:
Normal blood pressure
A systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg
Elevated blood pressure
A systolic pressure between 120 - 129 mm Hg and a diastolic pressure below 80 mm Hg
High blood pressure
Stage 1 hypertension
Systolic pressure between 130 - 139 mm Hg or diastolic pressure between 80-89 mm Hg
Stage 2 hypertension
Systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher
Hypertensive crisis
Systolic pressure greater than 180 mm Hg and/or diastolic pressure greater than 120 mm Hg
If you have high blood pressure or a hypertensive crisis, it is advisable to contact your doctor.
Definition of pulse pressure
Pulse pressure serves as an indirect marker of arterial stiffness. It can provide important information about your health, reflecting the force exerted on the arterial walls with each heartbeat. Pulse pressure is the numerical difference between the systolic and diastolic blood pressure values and is calculated by subtracting the diastolic pressure from the systolic pressure.1
Pulse pressure = systolic pressure – diastolic pressure
For example, if a person’s blood pressure reading is 120 mm Hg systolic pressure and 80 mm Hg diastolic pressure (120/80), the pulse pressure is 40 mm Hg (120 mm Hg – 80 mm Hg).
Pulse pressure categories
Pulse pressure levels are categorised as follows:
Normal pulse pressure
With a normal systolic pressure of less than 120 mm Hg and a normal diastolic pressure of less than 80 mm Hg, the normal pulse pressure is approximately 40 mm Hg.1
High/wide pulse pressure and low/narrow pulse pressure
A pulse pressure of more than 100 mm Hg is too high or too wide, whereas a pulse pressure of less than ¼ of the systolic pressure is too low or too narrow. For example, if the systolic pressure is 120 mm Hg, a pulse pressure of less than 30 mm Hg would be too low.1
Changes in pulse pressure with ageing
Arterial stiffness causes an increase in pulse pressure
As people age, arterial stiffness tends to increase, leading to an increase in pulse pressure. The increase in stiffness and consequent decrease in elasticity of the arteries is due to structural molecular changes in the arterial wall, including reduced elastin content, increased collagen I deposition, and calcification. The process of increasing arterial stiffness is often referred to as the ‘hardening of the arteries’ or more technically ‘atherosclerosis’. As the heart contracts against stiffer, less elastic arteries, systolic and diastolic blood pressures change and can lead to an increased pulse pressure. Systolic blood pressure usually tends to increase due to arterial stiffness and reduced elasticity, while diastolic pressure may decrease or remain stable. As a result, the pulse pressure widens, reflecting the increased force exerted on the arterial walls during each heartbeat.1
So how is this increase in arterial stiffness reflected in pulse pressure? As the heart contracts against stiffer, less elastic arteries, the systolic and diastolic blood pressures change and can lead to an increase in pulse pressure. Systolic blood pressure usually tends to increase due to arterial stiffness and reduced elasticity, while diastolic pressure may decrease or remain stable. As a result, the pulse pressure widens, reflecting the increased force exerted on the arterial walls during each heartbeat.1
Other causes of pulse pressure changes
In addition to arterial stiffness, several other factors can affect pulse pressure, including gender, physical activity level and overall cardiovascular health. In terms of gender, men tend to have higher pulse pressures than women. In addition, lifestyle factors such as smoking, obesity, and physical inactivity can contribute to elevated pulse pressure and adverse cardiovascular outcomes. Conversely, regular exercise, a balanced diet, and stress management techniques can help maintain optimal pulse pressure levels and promote heart health.1,3
Consequences of altered pulse pressure
Elevated pulse pressure can lead to an increased risk of adverse cardiovascular events, including stroke, heart attack, and ultimately death. In addition, elevated pulse pressure may reflect underlying abnormalities or diseases affecting the blood vessels, such as arterial stiffness (atherosclerosis), and can lead to atrial fibrillation, causing irregular and often rapid heartbeat that can lead to inefficient pumping of blood into the lower chambers of the heart and out of the heart to the rest of the body.1,3,4
Importance of early intervention
Early detection and intervention are key to managing elevated pulse pressure and reducing the associated cardiovascular risks in the ageing population. Regular monitoring of blood pressure and pulse pressure allows early detection of abnormalities, enabling timely intervention and risk reduction. By targeting potential risk factors and implementing appropriate management strategies, older adults can optimise cardiovascular function and improve their overall quality of life as they age.
Strategies for maintaining cardiovascular health
Management strategies aimed at optimising pulse pressure often include lifestyle changes such as dietary modification, quitting smoking, regular exercise, and weight loss. One of the most effective forms of exercise is endurance exercise, such as aerobic exercise, which has been shown to help reduce arterial stiffening by reducing the age-related increase in collagen and calcification.1,3 In addition, pharmacological treatment of hypertension and underlying cardiovascular disease may be prescribed to reduce pulse pressure and improve overall cardiovascular outcomes.1
FAQ’s
What is pulse pressure, and why is it important in assessing cardiovascular health?
Pulse pressure is the difference between the systolic and diastolic blood pressure readings. It reflects the force exerted on the arterial walls during each heartbeat and provides valuable information about cardiovascular function and health.
How is pulse pressure calculated?
Pulse pressure is calculated by subtracting the diastolic pressure from the systolic pressure. For example, if a person's blood pressure reading is 120 mm Hg systolic and 80 mm Hg diastolic (120/80 mm Hg), the pulse pressure is 40 mm Hg (120 mm Hg - 80 mm Hg).
What should my pulse pressure be?
Pulse pressure levels are categorised as follows:
- Normal pulse pressure: Approximately 40 mm Hg
- High/wide pulse pressure: More than 100 mm Hg
- Low/narrow pulse pressure: Less than 1/4 of the systolic pressure
How does pulse pressure change with ageing?
As people age, arterial stiffness tends to increase, leading to a widening of pulse pressure. This is caused by structural changes in the arterial wall, including reduced elastin content, increased collagen deposition, and calcification, collectively known as ‘atherosclerosis’ or ‘hardening of the arteries’.
What are the consequences of altered pulse pressure in ageing populations?
Elevated pulse pressure in older adults is associated with an increased risk of adverse cardiovascular events, including stroke, heart attack, and cardiovascular mortality. It may also indicate underlying vascular abnormalities or disease, such as atherosclerosis.
Why is early intervention important in managing pulse pressure?
Early detection and intervention are crucial for managing elevated pulse pressure and reducing associated cardiovascular risks. Regular monitoring of blood pressure, including pulse pressure, allows for timely intervention and risk reduction, ultimately improving cardiovascular outcomes. Management strategies include lifestyle modifications such as dietary changes, regular exercise, smoking cessation, and weight management. Additionally, pharmacological interventions targeting hypertension and cardiovascular disease may be prescribed to optimise pulse pressure and overall cardiovascular health.
Summary
The close relationship between pulse pressure and ageing underlines the critical need for proactive cardiovascular care and timely intervention. As we age, our bodies undergo changes that inevitably affect the health of our arteries, leading to changes in pulse pressure. This increase in pulse pressure is often an indicator of age-related arterial stiffening and can serve as an early warning sign of potential cardiovascular disease. However, regular monitoring of blood pressure, including pulse pressure, can help detect early disease and prevent its progression. Ways to manage cardiovascular health include a healthy diet and regular aerobic exercise, such as swimming or cycling. In addition, pharmacological interventions tailored to high blood pressure and related cardiovascular problems play a crucial role in optimising our cardiovascular outcomes. Overall, a vital lifestyle can reduce blood pressure abnormalities and regular monitoring can help you to manage and improve your cardiovascular health.
References
- Homan TD, Bordes SJ, Cichowski E. Physiology, pulse pressure. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. http://www.ncbi.nlm.nih.gov/books/NBK482408/.
- Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Archives of Internal Medicine. 2000;160(8): 1085. https://doi.org/10.1001/archinte.160.8.1085.
- Thorin-Trescases N, de Montgolfier O, Pinçon A, Raignault A, Caland L, Labbé P, et al. Impact of pulse pressure on cerebrovascular events leading to age-related cognitive decline. American Journal of Physiology. Heart and Circulatory Physiology. 2018;314(6): H1214–H1224. https://doi.org/10.1152/ajpheart.00637.2017.
- Anstey DE, Moise N, Kronish I, Abdalla M. Masked hypertension: Whom and how to screen? Curr Hypertens Rep [Internet]. 2019 [cited 2024 Mar 22]; 21(4):26. Available from: https://doi.org/10.1007/s11906-019-0931-1.
