Pulse pressure is an indicator of how stiff or flexible the arteries are and how well the heart pumps blood. Like high blood pressure, high pulse pressure is linked to heart disease. Find out why you should monitor your pulse pressure, what causes abnormal values, and how you can reduce yours if it is too high.
What Is Pulse Pressure?
When you go to the doctor to get your blood pressure checked, they’ll give you your result as a larger number (top) next to a smaller number (bottom), e.g. 120/80. The first number is your systolic blood pressure, and the second number is your diastolic blood pressure.
The heart rhythmically contracts and relaxes, pushing blood out and letting new blood in. The heart’s contraction is also called the systole, while its rest period is known as the diastole.
Hence, systolic blood pressure is the pressure in the arteries when the heart beats; diastolic blood pressure is the pressure in the arteries when the heart is resting.
Pulse pressure is the difference between these two measurements. Essentially, it tracks how much force the heart creates each time it contracts [1].
There are two main factors that determine pulse pressure [1]:
- How much blood the heart pumps each time it contracts
- How much the large arteries leaving the heart resist the blood pumped into them
Pulse pressure tends to increase as you age as the arteries become less elastic. High pulse pressure is a major risk factor for heart disease [2, 3].
Doctors look at pulse pressure to determine how healthy the heart and large arteries are to estimate the risk of heart disease [1].
How to Calculate Pulse Pressure
To calculate pulse pressure, simply subtract your systolic blood pressure (top number) from your diastolic blood pressure (bottom number). Like blood pressure, it is measured in millimeters of mercury (mmHg).
For example, if your blood pressure is 120/80 mmHg, your pulse pressure is 40 mmHg (120 – 80).
Equation
The equation for pulse pressure is:
(Systolic Blood Pressure) – (Diastolic Blood Pressure) = Pulse Pressure
Normal Range
The normal range for pulse pressure is between 40 mmHg and 60 mmHg [4, 1].
Importance for Health
If you have normal pulse pressure, your heart is pumping blood as it should and your arteries are adapting well by expanding and contracting. This maintains stable blood pressure [1].
Up until recently, it was believed that diastolic blood pressure could predict heart disease risk better than any other blood pressure measure. Today, it’s becoming clear that pulse pressure also plays a major role [5].
Pulse pressure is especially important in elderly people. Diastolic blood pressure tends to fall and systolic blood pressure increases with age, causing a steep rise in pulse pressure. A low diastolic blood pressure in elderly patients may give doctors a false impression of their risk of heart disease [2].
Wide Pulse Pressure
Definition
If your pulse pressure is greater than 60 mmHg, it is considered high, or “wide” [6].
What Does It Mean?
A wide pulse pressure means that the difference between your systolic blood pressure and diastolic blood pressure is large, or wide. It is generally a sign of arterial stiffness and may increase your risk for heart disease and other conditions [6].
High pulse pressure is especially dangerous when combined with a high systolic blood pressure [7].
This means that a blood pressure reading of 170/110 carries more risk than a reading of 130/70 (with the exact same pulse pressure of 60 mmHg).
Negative Health Effects
The following conditions are commonly associated with wide pulse pressure. Note, however, that the majority of studies covered in this section deal with associations only, which means that a cause-and-effect relationship hasn’t been established. Other genetic and environmental factors that may vary from one person to another could also contribute to these conditions.
1) Heart Disease
Wide pulse pressure is strongly linked to heart disease. Fatty plaque and calcium buildup (calcification) stiffen the arteries and widen pulse pressure [8, 9, 7, 3, 10].
One study followed over 11k healthy men for 11 years. In those older than 60 years, pulse pressure above 55 mmHg was linked to more than 40% increased incidence of heart disease compared to levels below 44 mmHg [9].
Some studies suggest a wide pulse pressure may be a stronger risk factor for heart disease than either systolic or diastolic blood pressure [7, 3, 10].
Heart Failure
Heart disease can lead to congestive heart failure, when the heart can no longer maintain normal blood flow. In a group of 1.6k elderly people, those with a pulse pressure above 67 mmHg had a 55% increased risk of congestive heart failure (compared to those with levels below 54 mmHg) [11].
Irregular Heartbeat
Pulse pressure is also linked to an increased risk of atrial fibrillation, a condition involving an irregular heartbeat [1, 12, 13].
In fact, one study on over 5.3k people found that every 20 mmHg increase in pulse pressure increased the risk of atrial fibrillation by 26% [12].
Heart Attacks
Wide pulse pressure was linked with more than a 2-fold increased incidence of heart attacks in a study on 2.2k patients with high blood pressure [14].
According to one study, pulse pressure predicts complications such as heart attacks, heart failure, or death better than either systolic or diastolic blood pressure [15].
In a study of over 2.2k people who previously had a heart attack, every 10 mmHg increase in pulse pressure was linked to a 12% increase in the incidence of future heart attacks [16].
Pulse pressure also strongly predicted the risk of a second heart attack in patients with high blood pressure [17].
Death
Wide pulse pressure increases the chance of death from heart disease and all causes, independent of other factors [18, 19, 20, 16, 21, 22].
In one study of over 7.3k people, each 10 mmHg rise in pulse pressure increased the risk of death due to heart disease by 20% [19].
Another study of over 4.7k people found that the risk of death due to all causes increased by 16% for every 10 mmHg increase [23].
In people older than 65 years, pulse pressure may be the best measure of blood pressure in determining the risk of dying from heart disease as well as from all-causes [24, 25, 26, 10].
2) Stroke
Stroke is the second-leading cause of death behind heart disease and the second-leading cause of disability behind dementia. Identifying patients at risk is crucial to help with prevention [27, 28].
High pulse pressure can damage blood vessels in the brain, leading to a stroke [29, 28].
In an observational study of over 22k heart disease patients, increasing levels of pulse pressure were directly linked to increased incidence of stroke [30].
Every 10 mmHg rise in pulse pressure increases the risk of stroke by 5-11%, according to studies on nearly 130k people [23, 28].
Hospitalized stroke patients with high pulse pressure are likely to suffer from greater disability after being released from the hospital [31].
3) Erectile Dysfunction
Patients with pulse pressure above 60 mmHg were 15% more likely to suffer from erectile dysfunction. Wide pulse pressure is a sign of stiff arteries, which reduces blood flow in the penis. Other studies confirmed the link between high pulse pressure and erectile dysfunction [32, 33, 34].
4) Preeclampsia
High pulse pressure may increase the risk of preeclampsia, a pregnancy complication involving high blood pressure. In one study, pulse pressure at 7-15 weeks was higher in expecting mothers who went on to develop preeclampsia [35, 36].
Symptoms
A wide pulse pressure does not cause any symptoms by itself. Your symptoms will be related to the underlying cause. For example, you may experience symptoms of high blood pressure including [37]:
- Headaches
- Dizziness
- Tinnitus
- Weakness
- Drowsiness
If you experience several of these symptoms, work with your doctor to determine what underlying condition is causing them and to develop an appropriate plan to improve your health.
Causes
1) Hardening of the Arteries
Hardened arteries (atherosclerosis) are the most common cause of wide pulse pressure. As we age, the arteries become stiffer due to the buildup of fatty plaques and calcium. The stiffening is worsened by the loss of elastin, a protein that allows arteries to resume their shape after stretching [38, 39].
2) Overactive Thyroid
An overactive thyroid (hyperthyroidism) can selectively lower diastolic blood pressure, resulting in wide pulse pressure [40].
3) Aortic Valve Regurgitation
The aortic valve allows blood to flow from the left chamber of the heart into the aorta, the largest artery in the body. Aortic valve regurgitation is when the aortic valve doesn’t close properly. As a result, blood flows back into the heart, which increases systolic and decreases diastolic blood pressure. In turn, pulse pressure widens [1].
4) Anemia
Severe anemia can cause wide pulse pressure by forcing the heart to beat faster and stronger to supply more oxygen to the body. This increases systolic and pulse pressures [39].
5) Low Testosterone
As men age, their testosterone levels often drop, which puts them at a higher risk of several health problems [41].
Older men with low testosterone (hypogonadism) have stiffer arteries, which can raise their pulse pressure and blood pressure. Testosterone therapy as skin patches can improve the elasticity of their arteries, according to a study of 18 older men with low testosterone [41].
Lower testosterone has been linked to higher pulse pressure, though it’s not clear whether the drop in testosterone directly causes pulse pressure to rise. In one study on almost 1.1k men, those with pulse pressure above 60 mmHg were twice as likely to have low testosterone levels [42, 32].
In transgender men, testosterone replacement therapy raises systolic blood pressure more than diastolic blood pressure. More research is needed to pinpoint the relationship between testosterone and blood pressure across different populations [43].
Complementary Approaches to Lower Pulse Pressure
The most important thing is to work with your doctor to find out what’s causing your high pulse pressure and to treat the underlying condition that may be causing it. The following complementary strategies may also help as an add-on to your treatment regime. Discuss with your doctor if they may be helpful in your case.
1) Exercise
You can reduce your pulse pressure by [44, 45, 46]:
- Moderate-intensity aerobic exercise such as cycling
- High-intensity interval training (HIIT)
HIIT involves bursts of intense exercise followed by short rest periods. A study of 245 people found that 3x/week of HIIT for 8 weeks reduced pulse pressure by 13 mmHg [47].
Avoid strength training, though – it may have the opposite effect. A study on 38 people found that strength-trained athletes have higher pulse pressure than people who don’t exercise at all [48].
2) Stop Smoking
Smoking stiffens the arteries and increases both blood pressure and pulse pressure, as seen in a study on over 300 people [49].
3) Reduce Sodium Intake
If you have a wide pulse pressure, aim to reduce your intake of salt and other high-sodium foods. Sodium-rich foods and salt harden the arteries [50, 51].
4) Reduce Alcohol Consumption
If you have a wide pulse pressure, stop (or cut down on) your drinking.
Heavy drinkers have higher pulse pressure than light drinkers, who have higher levels than nondrinkers, according to a study on almost 100k men [52].
Heavy drinking (more than 3 drinks a day) almost always raises systolic blood pressure more than diastolic blood pressure, thus raising pulse pressure increases [53].
5) Lose Weight
Losing weight may help reduce your wide pulse pressure.
Being overweight is directly linked to higher pulse pressure. According to one study of 220 obese people, a 10% reduction in BMI reduced pulse pressure by 9% [54, 55].
6) Get Enough Sleep
Make sure you are getting consistent, quality sleep every night. Even a single night of poor sleep can increase pulse pressure [56].
7) Beets
Beets are well-known for their blood pressure-lowering abilities. In one trial of 30 people, 500 g beetroot juice reduced pulse pressure by 1.5 mmHg over the course of 24 hours [57].
8) Cocoa
Flavanols belong to the family of antioxidant flavonoids. Flavanols in dark chocolate and cocoa can help lower pulse pressure. In a study on 32 healthy people, those eating flavanol-rich chocolate had a lower pulse pressure than those who ate chocolate low in flavanols [56].
9) Omega-3 Fats
In one study on 160 people, 6 g of fish oil (1:1 EPA:DHA) daily for 16 weeks decreased pulse pressure and reduced arterial stiffness [58].
10) Vitamin B9
In a 3-week study of 41 people, supplementing with 4 mg/day folic acid (vitamin B9) lowered pulse pressure by nearly 5 mm Hg and reduced arterial stiffness [59].
11) Vitamin K
Not getting enough vitamin K was linked to higher pulse pressure in an observational study of over 5k people [60].
Vitamin K may help prevent artery hardening by stopping calcium from building up in the lining of blood vessels [61, 62].
12) Aged Garlic Extract
In one study of 88 people with high blood pressure, taking 1,200 mg of aged garlic extract reduced pulse pressure by 4 mmHg over the course of 12 weeks [63].
In another study of 49 people with high blood pressure, aged garlic extract (1,200 mg) reduced pulse pressure by 5.5 mmHg over 12 weeks [64].
The extract seems to work by improving blood vessel health and reducing arterial stiffness. It may also increase beneficial gut bacteria; imbalances in the gut flora are linked to high blood pressure [64, 65].
To get the most out of supplementing with aged garlic extract, make sure you’re not deficient in any of these B vitamins:
These vitamins are needed to activate the compound in aged garlic extract responsible for improving arterial stiffness and blood pressure (hydrogen sulfide) [64].
Narrow Pulse Pressure
Definition
A pulse pressure that is less than 40 mmHg is considered low, or “narrow” [1].
What Does It Mean?
Having a narrow pulse pressure is a sign that your heart is not pumping as much blood as it should [1].
Negative Health Effects
The following conditions are commonly associated with narrow pulse pressure. Note, however, that the majority of studies covered in this section deal with associations only, which means that a cause-and-effect relationship hasn’t been established. Other genetic and environmental factors that may vary from one person to another could also contribute to these conditions.
1) Poor Outcomes in Advanced Heart Failure
In a study of 1.9k advanced chronic heart failure patients, only 48% of those with pulse pressure below 35 mmHg survived after three years, while more than 60% of those with pulse pressures above 35 mmHg were alive after three years [66].
Levels below 42 mmHg were linked to higher rates of hospitalization and death in another study of 2.2k heart failure patients [67].
In a group of 225 heart failure patients, 84% of those who died over a follow up of 2 years had pulse pressure below 30 mmHg [68].
2) Poor Outcomes in Stroke
In a study of more than 33K people with stroke, a pulse pressure below 30 mmHg was linked an 85% increased risk of disability in comparison to levels above 50 mmHg [69].
Symptoms
A narrow pulse pressure does not cause any symptoms by itself. Your symptoms will be related to the specific cause of your narrow pulse pressure. Work with your doctor to identify the underlying condition causing it and to develop a treatment plan.
Causes
1) Chronic Heart Failure
In chronic heart failure, the heart cannot pump blood as well as it should. In advanced cases, this can lead to a narrow pulse pressure [67, 70].
2) Aortic Stenosis
Another common cause of a narrow pulse pressure is aortic stenosis, a narrowing of the aortic valve that prevents blood from being released from the heart into the aorta. In turn, the heart pumps less blood, leading to both a lower systolic pressure and pulse pressure [1].
3) Significant Blood Loss
Significant blood loss results in the heart not being able to pump as much blood, greatly reducing pulse pressure [1].
Takeaway
Pulse pressure is the difference between the systolic (top number) and diastolic (bottom number) blood pressure. It tends to increase with age and is an independent risk factor for heart disease and stroke. High, or wide pulse pressure can be caused by stiff arteries, an overactive thyroid, and other issues relating to the heart. Reducing your salt intake, exercise, and certain supplements can help lower it. Low, or narrow pulse pressure is caused by advanced heart failure or narrowing of the aortic valve in the heart. You can greatly reduce your risk of heart disease by keeping your blood pressure and pulse pressure in check.
