Pulse Pressure is the difference between
the two blood pressure numbers

What Is It?

If you subtract the smaller blood pressure number from the larger one you get a number which is the Pulse Pressure. For example, a blood pressure of 120 over 80 yields one of 40 mm Hg (120 minus 80 = 40). Obviously it is the difference between the systolic and the diastolic pressures. Let's call it PP.

Thus there are three components to this (or any other) blood pressure reading: Systolic pressure (120), diastolic pressure (80) and pulse pressure (40). SBP, DBP and PP.

What Should the Pulse Pressure Be?

Studies have shown that this number should be no more than 60 mm Hg.

What Significance Does a High PP Have?

When greater than 60 mm Hg there is in increased incidence of adverse cardiovascular events especially in the older population.

In a study of over 5,000 men in Europe concluded in 2005 the risk of coronary heart disease for men with a PP of 70 or more was a whopping three times higher than that for men with less than 50. That is 200% more! Naturally, results were corrected for all other risk factors.

Men with hypertension had a 50% increase in major coronary events, at all ages.

The risk of coronary event associated with a PP of 70 or more was actually significantly higher than that associated with hypertension. Thus, PP may be a stronger predictor of risk than is hypertension.

It also appears to be an independent risk factor. In other words it adds risk to the other factors.

Generally, this phenomenon was not seen at less than 50 years of age, visible at 50-59, and strongest after 60.

In these three age groups: diastolic is more predictive in less than 50. At 50-59 systolic is most predictive and after 60 the pulse pressure is most important. As one ages there is a gradual shift in the strength of prediction of risk from diastolic to systolic to PP.

Results of several longitudinal studies in older patients with hypertension indicate that a high PP is a sensitive marker for carotid artery stenosis (narrowing), which increases the risk of stroke, coronary heart disease, and sudden death.

These results are consistent with those of the famous Framingham study in Massachusetts.

Other studies have somewhat differing results so the concept is not as clear as one would like. Some of the differences can be explained by differences in the study structure and by using different end-points such as mortality versus morbidity (events without death).

Doctor’s Practical Guide:

Which blood pressure is more desirable, 140/90 or 140/70 ? Most people (and probably doctors as well) would choose 140/70 as being best. But now you know that 140/90 is associated with less coronary heart events because the PP is less. 140/90 is the better blood pressure.

You might be thinking “Why haven’t I heard about this before?” The reason is that it is just now being recognized over the last 5 to 10 years. How long does it take to study the 10 year effect of something? 10 years, of course.

What should you do?

First, keep and eye on your blood pressure preferably by taking it yourself. (Actually, how else can you?) See this page How To Take Blood Pressure See also How To Take Blood Pressure Booklet

Second, if you see a wide pulse pressure tell your doctor so that you can be investigated for causes such as arteriovenous fistula, hyperthyroidism, etc.

Third, be aware that high blood pressure can be prevented by natural means such as weight control, diet, exercise, salt reduction and possibly by supplements. See Lower Blood Pressure See also Herbs That Lower Blood Pressure

Last, be aware that certain anti-hypertensive drugs and combinations thereof have a better effect on pulse pressure than others. Examples are diuretics and certain calcium channel blockers.

On a lighter note, you probably won’t run into this problem while you are under 50 years of age. But why not prevent it? Read more of these pages and learn how to control your blood pressure. Yourself, that is.