Pulse pressure (pulse amplitude, blood pressure amplitude)
Little known but important: pulse pressure. In this article you will learn more about the role pulse pressure plays for your health, how to determine your pulse pressure, and what research has found.
In this article:
What is pulse pressure?
Pulse pressure is the difference between systolic and diastolic blood pressure and is a measure of the elasticity of the large blood vessels. If the vessels are less elastic, blood flows through the body at higher pressure and pulse pressure increases. In other words: the higher the pulse pressure, the higher the resistance of the large vessels.
Pulse pressure and vascular resistance
To even out the pressure changes between systole and diastole, arteries close to the heart contain a high proportion of elastic fibers. This elasticity is needed to turn a pulsating flow into a continuous blood flow. For this reason, the main artery (the aorta) and the carotid artery (Arteria carotis communis) are referred to as elastic-type arteries (arteria elastotypica).
Reminder: arteries are the vessels that carry oxygen-rich blood from the heart into the circulation. Veins return oxygen-poor blood back to the heart.
The pronounced elasticity of the aorta is called the Windkessel function of the aorta. The comparison to a "Windkessel" originally comes from hydraulics: a Windkessel is usually an air-filled vessel that evens out pressure fluctuations in fluid lines. It is used in systems with pumps or compressors to ensure a steady flow. When a compressor pushes fluid into a system, pressure in the Windkessel rises and the air inside is compressed. When pressure falls, the air expands and pushes the remaining fluid along.
The aorta follows the same principle, except elastic vessel walls compensate the pressure wave here, not compressed gases like air.
A Windkessel is used to extend the life of a pump or compressor because it prevents the device from having to run at maximum output all the time. Just as a Windkessel protects the compressor from overload, the Windkessel function of the aorta protects the heart. If the Windkessel function of the aorta decreases, for example due to calcification, the heart must work harder and pressure in the vessels rises because of the lost elasticity systolic blood pressure and pulse pressure increase.
Calculating pulse pressure
Pulse pressure is calculated by subtracting the diastolic blood pressure from the systolic blood pressure:
Pulse pressure = Systolic blood pressure – Diastolic blood pressure
You can follow the calculation with a simple example:
Systolic blood pressure : 120 mmHg
Diastolic blood pressure: 80 mmHg
Pulse pressure: 120-80 = 40 mmHg
Pulse pressure is given in millimeters of mercury (mmHg), the same unit used for blood pressure.
Current findings on pulse pressure
While blood pressure plays a fundamental role in medicine, pulse pressure has only received more attention in the last two decades. A particular link appears to exist between increased pulse pressure and the risk of cardiovascular events. Cardiovascular events can affect all parts of the heart and blood vessels. Examples include arrhythmias, heart attack (myocardial infarction), or stroke.
Some scientific studies have already shed light on the relevance of pulse pressure:
Pulse pressure and cardiovascular events
Existing scientific studies suggest that in middle-aged and older people pulse pressure may be a more reliable predictor of cardiovascular events than the individual systolic and diastolic blood pressure values.
In people with high blood pressure: An analysis combining three studies with more than 7,900 participants concluded that a 10 mmHg higher pulse pressure in people with hypertension could predict a greater likelihood of cardiovascular complications. A link with mortality was also observed. However, it is not clear whether these findings apply to younger people.
In people without cardiovascular disease: A study that followed 1,924 women and men without cardiovascular disease or blood pressure medication for an average of 14 years showed similar results: pulse pressure was (slightly) more informative for predicting coronary heart disease (CHD) than systolic or diastolic blood pressure. It was observed that CHD risk was higher with rising pulse pressure while systolic blood pressure stayed the same, than with rising systolic blood pressure and unchanged pulse pressure. This could mean that people with purely elevated systolic blood pressure (isolated systolic hypertension) might have a higher CHD risk than people with elevations in both systolic and diastolic values. This relationship is still debated in research, because in heart failure these findings were not observed both isolated systolic hypertension and high systolic and diastolic blood pressure led to similar rates of heart failure (25% and 22%).
Atrial fibrillation is the most common chronic heart rhythm disorder in adults and increases the risk of death and stroke. Since higher systolic blood pressure is among the risk factors for atrial fibrillation, researchers asked whether pulse pressure might also be related. One study followed 5,331 women and men for 20 years and found that higher pulse pressure was an important predictor for future atrial fibrillation. The study recommends considering pulse pressure when interpreting blood pressure to include the risk for atrial fibrillation.
Pulse pressure and stroke
A stroke occurs when there is a disturbance of blood flow (ischemic) or bleeding (hemorrhagic) in the brain. High blood pressure and heart disease are two of many risk factors that increase stroke risk. One study showed that increased pulse pressure can be a factor that influences stroke risk. Pulse pressure, however, was not as good at predicting death systolic blood pressure was more informative for that.
Interpreting pulse pressure
With BloodPressureDB you can monitor your pulse pressure. The app shows not only systolic and diastolic blood pressure but also heart rate and pulse pressure in a chart. That way you can follow how pulse pressure changes over time.
That may sound complicated, but it can be explained with the following example:
In this image you can see a display of normal blood pressure and pulse pressure values as shown in the app.
For comparison: blood pressure from 140/90 mmHg is considered high blood pressure.
The green and red lines show systolic and diastolic blood pressure. Heart rate is shown in blue and pulse pressure in yellow.
In this example, the blood pressure on May 1, 2021 is 129/87 mmHg. This is within the normal range and gives a pulse pressure of 42 mmHg (129 – 87 mmHg = 42 mmHg). Small blood pressure fluctuations can be seen over time, while pulse pressure fluctuates less, as shown by the yellow line. By the end of the recording on October 13, 2023 the pulse pressure is about 43 mmHg. The yellow line shows a slight increase in pulse pressure over time.
In most cases, an increase in pulse pressure is a slow process, so its worth recording measurements regularly and over a long period. If pulse pressure continued to rise in this example, a visit to a doctor would be recommended.
Normal values for pulse pressure
There are no official cut-off values for an abnormal pulse pressure. In healthy people it is usually below 50 mmHg.
If you are unsure about your pulse pressure values or they are rising, ask your doctor for advice. The more accurately and frequently you record blood pressure and pulse pressure values, the better they can be interpreted.
How is pulse pressure measured?
Many automatic blood pressure monitors display pulse pressure. If a device does not show pulse pressure or if you measure manually, you can calculate pulse pressure by subtracting the diastolic value from the systolic value.
Causes of high pulse pressure
Endurance exercise
Increased pulse pressure can occur in trained endurance athletes, for example long-distance runners. The reason is that endurance training increases the heart muscle, allowing more blood and therefore more oxygen to be pumped through the body. Because of the higher blood flow and stroke volume, systolic blood pressure increases. Diastolic blood pressure falls due to the lower resistance in the vessels. This happens because regular endurance exercise produces more slow-twitch muscle fibers in the walls of the small blood vessels (arterioles) than fast-twitch fibers resistance and pressure drop.The result: the gap between systolic and diastolic values widens and pulse pressure rises. People with a large amount of muscle mass can also have increased pulse pressure.
In general, an active lifestyle promotes health. Whether higher pulse pressure in very athletic people affects health is still unclear.
Age
During the natural aging process, the large arterial vessels become stiffer. Over time the vessel walls remodel: elastic fibers (elastin) decrease while rigid collagen I and calcifications increase. The result: the left ventricle pumps blood through "stiffer" vessels into the circulation and must work against a higher vascular resistance than with elastic vessels pulse pressure rises.
Because of the increased workload, the left ventricle enlarges over time, a change health professionals call hypertrophy. Higher pulse pressure in the small vessels of organs, for example in the brain or kidneys, can lead to tissue damage.
Typically, systolic blood pressure increases with age while diastolic blood pressure decreases.
If only systolic blood pressure rises above 140 mmHg, health professionals call this isolated systolic hypertension. Isolated systolic hypertension is the most common form (75%) of high blood pressure in previously untreated people over 75 years old. Younger people can also have isolated systolic hypertension, although simultaneous increases in systolic and diastolic are more common. This form of high blood pressure is associated with an increased risk of serious cardiovascular disease and should be treated persistently.
An example
Herbert has a regular blood pressure of 150/95 mmHg. According to medical guidelines these values are too high and are considered high blood pressure.
Manfred has a regular blood pressure of 150/80 mmHg. In Manfred the systolic value (150 mmHg) is elevated while the diastolic value (80 mmHg) is in the normal range this is called isolated systolic hypertension.
Should Herbert and Manfred visit their family doctor's office because of their blood pressure values?
Yes both Herbert and Manfred should have their blood pressure checked by a doctor, because most medical societies recommend treatment when the systolic pressure is high, and also when both systolic and diastolic pressures are elevated.
Conditions
An increased or widened pulse pressure can be caused by different conditions. Here are some examples:
- Aortic valve regurgitation
- Aortic sclerosis: increased vascular resistance
- Severe iron deficiency: changes in blood viscosity
- Atherosclerosis
- Overactive thyroid (hyperthyroidism): increased systolic blood pressure
Causes of low pulse pressure
Conditions
A low or narrow pulse pressure can occur with the following conditions:
- Heart failure: the heart pumps blood through the body with insufficient pressure.
- Blood loss: if the heart has little volume/blood to pump, pulse pressure falls. This can happen, for example, after an injury from a traffic accident.
- Aortic stenosis: when the aorta is narrowed, pressure before the narrowing is high but too low afterwards; as a result, a low pulse pressure may be measured.
- Pericardial tamponade: if fluid collects between the heart and the pericardium (for example due to bleeding from a coronary vessel), the heart is compressed from the outside and can only pump insufficient amounts of blood into the circulation. Pericardial tamponade is a rare condition. Affected people usually feel very unwell, have shortness of breath, palpitations (a racing heart) and circulatory problems.
Do men and women have the same pulse pressure?
Women in young adulthood are less likely than men to have an elevated pulse pressure. At older ages, however, womens pulse pressure rises faster and more steeply than mens. A study that compared 22 studies found that this difference also exists in nonindustrialized countries. That suggests the results are mainly due to the human aging process rather than to a particular lifestyle.
This suggests that cardiovascular health should be monitored especially closely in older women.
Conclusion
Studies have shown that an increased pulse pressure may particularly predict cardiovascular events. Middle-aged and older people could especially benefit from regular monitoring of their pulse pressure.
Isolated systolic hypertension is the most common form of high blood pressure in older people. When systolic pressure rises while diastolic pressure stays the same or falls, pulse pressure increases. These findings could mean that isolated systolic hypertension is associated with a higher risk of cardiovascular events than hypertension in which both systolic and diastolic pressures are elevated. Future studies could clarify this question.
It is still unclear whether these findings are relevant for younger people and whether the observed links between pulse pressure and cardiovascular disease are coincidental or reflect a true causal relationship.
However, pulse pressure should not be considered normal just because the diastolic blood pressure is high. High diastolic blood pressure increases the risk of developing coronary heart disease, whether only the diastolic pressure is elevated or whether the systolic pressure is elevated as well. A normal pulse pressure should therefore always be based on normal diastolic blood pressure values and never on an elevated diastolic pressure.
Tip:
Sources:
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This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2024).
Author Dr. med. univ. Lisa Raberger studied medicine at the Medical University of Vienna and gained broad clinical experience in several hospitals. Now working full-time as a medical writer, she conveys evidence-based expertise to a worldwide audience and ensures reliable, easy-to-understand information.
Author Dr. med. univ. Lisa Raberger studied medicine at the Medical University of Vienna and gained broad clinical experience in several hospitals. Now working full-time as a medical writer, she conveys evidence-based expertise to a worldwide audience and ensures reliable, easy-to-understand information.
