Pulse Pressure

What is pulse pressure?

Pulse pressure is the difference between the upper and lower numbers of your blood pressure. Pulse pressure tends to increase as you get older. But it can also be a sign of cardiovascular problems before you develop symptoms.

Maybe you’ve only heard about pulse pressure recently and now it’s taking over your thoughts. Keep in mind that it’s just one measure of your health. When looking at the whole picture, a provider will look at many aspects of your health instead of just this one number.

How to calculate pulse pressure

When you check your blood pressure, you get two numbers, the systolic pressure (the top number) and the diastolic pressure (the bottom number). The systolic pressure measures how much pressure is on your arteries each time your heart squeezes. The diastolic pressure is how much pressure is on your arteries when your heart relaxes.

The pulse pressure formula is the difference between the higher number and the lower number of your blood pressure.

• Example: If your blood pressure was 120/80 millimeters of mercury (mmHg), the pulse pressure would be 120 - 80 = 40.

A normal pulse pressure is 40 mmHg.

When making a pulse pressure calculation, it’s important to know that your arteries become less stretchy and flexible (compliant) as you get older. This is natural. Arteries also tend to be stiffer in people with diabetes and chronic kidney disease.

With less arterial compliance and more arterial stiffness, here’s what usually happens after age 50:

• Your systolic blood pressure (top number) keeps going up.
• Your diastolic blood pressure (bottom number) drifts down.

This is why your pulse pressure gets higher as you age.

Why does my pulse pressure change when I take my blood pressure a few minutes apart?

Pulse pressure variation is normal and expected. When you breathe, your heart reacts by increasing how much blood it pumps. These changes in pulse pressure are usually very small, about five to 10 mmHg. Your blood pressure can vary from moment to moment, by time of day and by body position.

What does a wide pulse pressure mean?

A wide pulse pressure — sometimes called a high pulse pressure — means there’s a wide difference between the top and bottom numbers. For people who aren’t physically active, wider pulse pressures can indicate problems either now or in the future. People with a wide pulse pressure may already have a leaky or narrow aortic valve or atherosclerosis. In the hospital, people with an infection or inflammation can show a wide pulse pressure, as well.

Healthcare providers consider a pulse pressure higher than 100 mmHg to be a truly widened pulse pressure. But even as pulse pressure rises above the normal of 40 mmHg, the risk of problems with your heart and blood vessels goes up, even with small increases. Every 10 mmHg increase in your pulse pressure can raise your risk of coronary artery disease by 23%.

Pulse pressures of 50 mmHg or more can increase your risk of:

• Heart disease.
• Heart rhythm disorders (arrhythmia).
• Stroke.

Higher pulse pressures may also play a role in eye and kidney damage from diseases like diabetes.

While wider pulse pressures also happen in very active people, like long-distance runners, providers don’t consider it a problem for them. This is because runners’ hearts pump more blood than the average person’s. Runners also have flexible, healthy arteries because of their regular activity.

What does a narrow pulse pressure mean?

A narrow pulse pressure — sometimes called a low pulse pressure — is a pulse pressure that’s one-quarter or less of your systolic pressure (the top number). This happens when your heart isn’t pumping enough blood, like in heart failure and cardiac tamponade. It also happens when you lose a lot of blood or bleed internally from an injury.

Why is managing my pulse pressure important?

Managing your pulse pressure is important because a higher pulse pressure means your heart is working harder than usual, your arteries are less flexible than they should be or both. Both issues increase your risk of heart and circulatory problems, especially a heart attack or stroke. The risk is even greater when it’s both at the same time — which it commonly is, especially in adults older than 55.

What can I do to manage my pulse pressure?

Managing your pulse pressure goes hand-in-hand with taking care of your overall blood pressure. There are many ways to take care of your blood pressure:

• Get a yearly checkup. High blood pressure and related problems usually don’t have symptoms until they’re very advanced, so a yearly checkup or physical with your provider is essential to catch problems early.
• Eat nutritious foods. Foods low in sodium and salt can help you manage your blood pressure. Your provider may recommend a limit of 2,300 mg of salt per day or less.
• Stay active. Physical activity is good for your heart and your circulation. The aerobic kind of activity is especially helpful.
• Drink alcohol in moderation. The recommended limit for people assigned female at birth (AFAB) is one alcohol-containing drink per day (no more than seven per week) or two alcohol-containing drinks per day for people assigned male at birth (AMAB) (no more than 14 per week). Drinking more than these amounts can cause higher blood pressure.
• Know your risks. Tell your primary care provider if you have a family history of heart problems, high blood pressure, diabetes or high cholesterol. Having a family history of any one of these can increase your risk for one or more of the others.
• Take your meds. If your provider finds your blood pressure is higher than it should be and prescribes medication, take your medicine as directed. If you only take it when you remember to or when you have a visit with your provider coming up, you’re at risk for future problems.
• Check yourself. If you want to monitor your blood pressure on your own, you can get a blood pressure cuff online or from most pharmacies. Taking your blood pressure regularly can help you know if your pressure tends to be higher than it should, which you can discuss with your healthcare provider.

When should I call my provider or get medical care for my pulse pressure?

If you check your blood pressure regularly and notice you have an unusually wide (60 mmHg or more) or narrow pulse pressure (where your pulse pressure is less than one-quarter of the top blood pressure number), you should schedule an appointment with your healthcare provider to talk about it.

A note from Cleveland Clinic

It can be confusing to see your blood pressure numbers going in different directions. Talk to your primary care provider about whether it’s from aging or a health condition. They may use your pulse pressure to get more information about your heart and blood vessel health. If you have questions about your pulse pressure or blood pressure, your provider is a great resource. They can answer questions and direct you to other experts or sources of information. That way, you can feel better prepared for whatever comes next.