What Is Pulse Pressure?

Overview

When you check your blood pressure, you get two numbers: upper (systolic) and lower (diastolic). Pulse pressure is the difference between two numbers, systolic and diastolic blood pressure.¹

While pulse pressure varies from person to person, having a pulse pressure too wide or too narrow can increase the risk of heart attack and other heart-related diseases.²

• Systolic blood pressure (the first number) shows how much your blood exerts against your artery walls when the heart beats. 
• Diastolic blood pressure (bottom number): indicates how much pressure your heart exerts against your artery walls while the heart muscles are resting between contractions.⁴

Pulse pressure tends to increase as you get older; it significantly increases after the age of 50 as a result of arterial wall stiffness with the associated increase in systolic blood pressure and a decrease in diastolic blood pressure.¹⁰

Pulse pressure is also an important indicator of heart conditions and can serve as an early indicator of heart attack and strokes.¹

Signs and symptoms of pulse pressure

The  most common signs and symptoms of pulse pressure are:

• Chest pain
• Fainting
• Lightheadedness or dizziness
• Palpitation
• Fluttering in the chest
• Pounding heartbeat
• Chest tightness⁶

How to measure pulse pressure?

Systolic blood pressure indicates how much pressure your arteries are under each time your heart beats. You can calculate the pulse pressure by subtracting a diastolic number from the systolic pulse number. 

It is important to note that your pulse pressure differs from your pulse or heart rate, which measures the number of times your heartbeats per minute.² Pulse pressure is measured in millimetres of mercury(mmHg). For example, a standard blood pressure is 120/80 mmHg. 

To calculate pulse, you must subtract the bottom number from the top number, for example: 

Pulse pressure = systolic pulse pressure – diastolic pulse pressure 

If your blood pressure were 120/80 Hgmm, that would be 120-80= 40 Hgmm. The difference between diastolic and systolic blood pressure (120-80) is 40 Hgmm, the pulse pressure. Experts suggest that 40mmHg is the ideal pulse pressure for any healthy individual.³

In some people, a 10 mmHg increase in pulse pressure can increase the risk of heart disease by 20%. 

Use the following guidelines to understand the various stages of hypertension:

Normal blood pressure: 120/80 Hgmm.

Low blood pressure: 90/60 Hgmm or less, also called hypotension.

High blood pressure: 120-129/80 or less. also known as hypertension. 

• Stage 1 hypertension (mild): 130-139/80-89 Hgmm
• Stage 2 hypertension (moderate): 140/90 Hgmm or higher 
• Stage 3 hypertension (emergency): 180/90 Hgmm 

A blood pressure reading or symptoms at this level or higher, such as shortness of breath or chest tightness, is considered a medical emergency. It is because of life threatening risks of stroke or other cardiovascular events.⁷

Conditions and disorders

What causes wide or high blood pressure?

A high pulse pressure or wide plus pressure is above 60 mmHg. While it's common for the pulse to increase as we get older, pulse pressure above 60 mmHg could be a sign of significant health conditions such as heart attack, stroke and other heart diseases, especially in older people. 

In the absence of an underlying cause, wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risks for mortality, disease progression and other metabolic diseases.¹

Medical conditions that can contribute to the high risk of high pulse pressure include:

• Atherosclerosis: characterized by the stiffening of the heart's arteries; this can happen when fluid builds up in the blood vessels. This condition is more common as you get old or If you receive a diagnosis of metabolic disorders. Stiffened arteries can cause increased systolic blood pressure and reduce diastolic blood pressure  
• Hyperthyroidism: alteration of thyroid functions can cause changes in blood pressure and other cardiovascular risk factors. As a result of an increase in thyroid hormone levels, your systolic blood pressure can increase and lead to wide pulse pressure⁸
• Aortic regurgitation: inadequate closure of the aortic valve during diastole that results in reverse blood flow through the aortic valve. This condition can cause a reduction in diastolic blood pressure, which can widen the gap between systolic and diastolic blood pressure⁸
• Age: As people age, it's common for their pulse pressure measurement to widen. 
• Stroke volume: the main determinants of pulse pressure are stroke volume (the amount of blood pumped out of the heart at each heartbeat) and arterial compliances. Pulse pressure is highly dependent on the stroke volume and is, therefore, influenced by all factors that determine stroke volume¹²

What causes narrow or low blood pressure? 

A narrow pulse pressure, also called a low pulse pressure, is when your pulse pressure is a quarter or less than your systolic pulse pressure. This is because the heart is not pumping enough blood and oxygen to your muscles and organs. Narrow pulse pressure can lead to heart failure and other heart valve diseases. This also happens when a person significantly suffers loss of blood due to injury or heavy bleeding.⁷

Some other causes of narrow pulse pressure may include:

• Heart failure: your heart isn't pumping enough blood to keep up with the body's needs 
• Aortic stenosis: a condition that occurs when the blood vessels between the heart and aorta become narrow, which can limit blood flow when heart muscles contract
• Cardiac tamponade : this condition arises when too much fluid builds up in the sac around the heart. It can also lead to low cardiac output

Clinical implications of pulse pressure

The association between risk factors and systolic pulse pressure creates an apparent anomaly in the importance of diastolic pulse pressure. Although treatment guidelines focus on the importance of systolic blood pressure control, in clinical practices, systolic blood pressure is not as controlled as diastolic blood pressure.

Unfortunately, there is little guidance on the role of pulse pressure in identifying high-risk individuals suitable for drug treatment. Few studies in hypertension and heart failure have evaluated the effect of drug treatment, especially in reducing pulse pressure and arterial stiffness.

Clearly, further studies are required in the form of placebo-controlled studies performing a direct comparison of the effects of the different classes of antihypertensive agents on atrial function, pulse pressure and subsequent cardiovascular morbidity and mortality.¹¹

FAQs

Why is managing my pulse pressure important?

Managing pulse pressure is important. Higher pulse pressure means your heart is working hard, which reflects increased arterial stiffness due to medical conditions or ageing. 

Regularly monitoring pulse pressure can identify your risk of developing cardiovascular disease at early stages. Normal pulse pressure ranges from 40 mmHg to 60 mmHg. If your pulse pressure is higher than 60 mmHg, it is considered a risk factor for developing heart disease, especially for older people. Therefore, it is crucial to check your pulse pressure regularly and take immediate action if your pulse pressure is higher or lower than normal.⁵

How can I manage my pulse pressure?

Managing pulse pressure is equally important as taking care of your overall blood pressure. Making a few lifestyle changes can help maintain the pulse pressure:

• Maintain a healthy weight: weight loss certainly helps reduce blood pressure if you are overweight 
• Low sodium: eating a low sodium diet, typically under 2,300 mg of salt per day, can help manage your blood pressure
• Eat healthier: eating a balanced diet, lots of fruits and veggies, low-fat dairy and less saturated and total fat loss. Limiting alcohol can significantly improve heart health
• Stay active: physical activity is good for your heart and blood circulation. Aiming for a 30-60-minute walk every day can reduce the risk of high blood pressure⁶

When should I call a doctor or seek medical help?

Individuals who suffer from high or low blood pressure should seek medical advice to find out the best treatments, which may include medications or lifestyle changes.²

A person taking medications should measure blood pressure regularly since the condition may not have apparent symptoms. Taking blood pressure readings is the best way to know if you have high blood pressure.

If you check your blood pressure and notice you have unusual wide (60 mmHg) or narrow pulse pressure (less than a quarter of the top blood pressure, you should schedule an appointment with your healthcare provider.³

Summary

Pulse pressure is the difference in number between systolic and diastolic blood pressure. Experts recommended that an ideal pulse pressure is 40-60 Hgmm. Wide or narrow pulse pressure could be a sign of medical conditions affecting overall heart health.

Systolic and diastolic blood pressure are important to know for treating a range of conditions such as strokes, heart attacks and various other cardiovascular diseases. If you have questions about pulse pressure, blood pressure and how this system functions, the primary care provider can be a great resource.

Fortunately, treatments are available to keep your pulse and blood pressure under control. Eating healthy diets and incorporating physical activity in your daily life can improve pulse pressure.