High blood pressure is a good indicator of heart disease and stroke risk, but researchers are now exploring the value of taking pulse pressure to diagnose these condition
Your doctor checks your blood pressure at just about every visit, but why? High blood pressure, or hypertension, increases your chance of heart disease and stroke — and often there are no symptoms of high blood pressure other than the results of your reading at the doctor’s office.
But a new clue is emerging in the quest to understand cardiovascular risk factors: pulse pressure.
What Is Blood Pressure?
Blood pressure is the force with which blood pushes against artery walls as it flows throughout your body — the pressure that the blood exerts. Blood pressure is always expressed as two numbers, both measured in millimeters of mercury (mm Hg). The systolic pressure (first or top number) measures the force when your hearts beats; the diastolic pressure (second or bottom number) is a measurement of the heart at rest. For example, someone with a systolic reading of 120 mm Hg and a diastolic reading of 80 mm Hg would have a blood pressure of 120 over 80.
If systolic pressure goes up — even if the diastolic pressure stays the same — the patient is at risk for developing serious cardiovascular conditions.
What Is Pulse Pressure?
The term pulse pressure might be new to you — it’s the difference between your systolic pressure and your diastolic pressure. If your blood pressure is 120/80, then your pulse pressure is 40 — the difference between 120 mm Hg and 80 mm Hg.
If systolic pressure increases — even if the diastolic pressure stays the same — your pulse pressure will increase, which seems to be an indicator of cardiovascular disease in some patients.
Though the correlation isn’t clear, studies have found a definite link between elevated pulse pressure and:
Increased risk of coronary artery calcification in patients with chronic kidney disease
The presence of cardiovascular disease, not just increased risk
Increased risk of atrial fibrillation
Increased risk of mortality from cardiovascular disease, particularly heart disease
Changing Diagnostic Standards
Though the current standard to determine heart disease risk is by measuring blood pressure, that doesn’t mean it’s the best indicator. And even though an increase in pulse pressure seems to be a good indicator of cardiovascular risk, there isn’t enough information to show how or why high pulse pressure may be a better predictor of heart disease risk than blood pressure readings. These are topics currently under research.
“One of the issues researchers are discussing pertains to the most appropriate, efficient way to measure blood pressure,” says Randy Wexler, MD, MPH, FAAFP, assistant professor of clinical family medicine at the Ohio State University in Columbus.
Another question under discussion: What do we do with the knowledge that pulse pressure is related to cardiovascular risk?
“The literature shows that there’s a relationship between pulse pressure and heart disease,” says Dr. Wexler. But, “there’s nothing that says if pulse pressure is ‘this,’ then do ‘that.'” Should that information become clearer in clinical studies, the next important step is to figure out how to use both blood pressure and pulse pressure to make diagnoses, he says.
The lack of definitive evidence regarding pulse pressure as a way to predict health risks means it’s doubtful that many doctors will measure pulse pressure when you go for an appointment. But as more research is conducted and we learn what insights pulse pressure can provide, that may certainly change.