Pulse Pressure

Overview

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, and this number can also be an indicator of health problems before you develop symptoms.

How does pulse pressure work?

Your blood pressure is measured using two numbers, the systolic pressure and the diastolic pressure. The systolic pressure is the top number, and it’s a measurement of how much pressure your arteries are under each time your heart beats. The diastolic pressure, which is the bottom number, is how much pressure your arteries are under between heartbeats.

These pressures are measured in millimeters of mercury (abbreviated “mmHg” because of the elemental symbol for mercury). This is because the first sphygmomanometers (pronounced “sfig-mo-ma-nom-et-er”) used to measure blood pressure had mercury in them. Mercury isn’t used anymore in these devices, which are also usually called blood pressure cuffs, but millimeters of mercury is still used.

To calculate your pulse pressure, all you have to do is subtract the bottom number from the top number.

  • Example: If your blood pressure was 120/80 mmHg, that would be 120 - 80 = 40.

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 reflexively reacts by increasing how much blood it pumps. These variations in pulse pressure usually are very small, about five to 10 mmHg. If you do take your blood pressure more than once, add each pulse pressure amount together and divide by two to find the average*.

Let’s say you have two pulse pressures, taken five minutes apart, with the first being 42 and the second being 38. You’d calculate your pulse pressure using the following steps:

  1. Add the two pulse pressures together. 42 + 38 = 80
  2. Divide the total from step 1 by the number of times you took the measurement, in this case, twice. 80 / 2 = 40
  3. The number you got in step 2 is average pulse pressure is 40.

*Note: If you do this, tell your doctor how many times you took your pressure to calculate this average and how long you waited between each measurement.

Why does pulse pressure matter?

The arteries that carry your blood are naturally stretchy and flexible, but they can only hold so much blood at any time. This is called arterial compliance. Your arteries also get less flexible and stretchy as you grow older, which is natural and expected. This is sometimes referred to as arterial stiffness. Arteries also tend to be stiffer in people with diabetes and chronic kidney disease.

Your blood pressure and pulse pressure can be valuable information for your healthcare provider, helping them spot a wide variety of heart and circulatory problems.

Conditions and Disorders

What does a wide pulse pressure mean?

A wide pulse pressure — sometimes called a high pulse pressure because the number is greater — means there’s a wide difference between the top and bottom numbers. For individuals who aren’t physically active, wider pulse pressures can indicate serious problems either now or in the future.

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. Pulse pressures of 50 mmHg or more can increase your risk of heart disease, heart rhythm disorders, stroke and more. Higher pulse pressures are also thought to play a role in eye and kidney damage from diseases like diabetes.

While wider pulse pressures also happen in very active people, such as long-distance runners, it isn't considered a problem for them. This is because their heart pumps more blood because they're active, and their arteries are healthy and more flexible because of their regular exercise.

What does a narrow pulse pressure mean?

A narrow pulse pressure — sometimes called a low pulse pressure — is where your pulse pressure is one-fourth or less of your systolic pressure (the top number). This happens when your heart isn’t pumping enough blood, which is seen in heart failure and certain heart valve diseases. It also happens when a person has been injured and lost a lot of blood or is bleeding internally.

Care

Why is managing my pulse pressure important?

Managing your pulse pressure is important because a higher pulse pressure means your heart is working harder, your arteries are less flexible or both. Either of the two increases your risk of heart and circulatory problems, especially heart attack or stroke. The risk is even greater when it's both at the same time — which it commonly is, especially in adults over the age of 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. It's best if you do the following 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 a healthy diet. A diet low in sodium and salt — typically under 2,300 mg of salt per day, but lower if your provider recommends it — can help you manage your blood pressure. Your primary care provider can offer suggestions on diets that fit this guideline.
  • Stay active. Physical activity is good for your heart and your circulation.
  • Drink alcohol in moderation. The recommended amount for women is one alcoholic drink per day (no more than seven per week) or two alcoholic drinks per day for men (no more than 14 per week). Drinking more than these recommended 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 doctor 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've got a doctor's visit coming up, you're at risk for future problems.
  • Check yourself. If you want to monitor your blood pressure on your own, blood pressure cuffs are available in most pharmacies or online. Taking your blood pressure regularly can help you identify if your pressure tends to be higher than it should, which you can discuss with your healthcare provider.

When should I call my doctor or get medical care for my blood pressure?

High blood pressure doesn’t usually have symptoms until it’s dangerously high. Taking your blood pressure regularly — at least once a year during a checkup with your primary care provider — is the best way to know if you have high blood 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. Use the following guidelines to understand blood pressure and the various stages of hypertension:

  • Low blood pressure: 90/60 mmHg or lower. Also known as hypotension (the prefix “hypo” means low).
  • Normal: 120/80 mmHg or lower. Sometimes called “normotension.”
  • Elevated blood pressure. 120-129/less than 80 mmHg. This is sometimes called pre-hypertension.
  • Stage I hypertension (mild): 130-139/80-89 mmHg.
  • Stage II hypertension (moderate): 140/90 mmHg or higher.
  • Stage III hypertension (emergency): 180/120 mmHg or higher with symptoms. Pressure readings and symptoms, such as chest pain or shortness of breath, at this level or higher, are a medical emergency. This is because of the life-threatening risk of stroke, aneurysm or other deadly events.

A note from Cleveland Clinic

Your pulse pressure is a number that can help you better understand your body and live a healthier, happier life. If you have questions about your pulse pressure, blood pressure or how any of your body systems are functioning, your primary care provider can also be 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.

Last reviewed by a Cleveland Clinic medical professional on 07/28/2021.

References

  • Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L,et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000;160(8):1085e9. Accessed 8/23/2021.
  • Grassi P, Lo Nigro L, Battaglia K, Barone M, Testa F, Berlot G. Pulse pressure variation as a predictor of fluid responsiveness in mechanically ventilated patients with spontaneous breathing activity: a pragmatic observational study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722341/) HSR Proc Intensive Care Cardiovasc Anesth. 2013;5(2):98-109. Accessed 8/23/2021.
  • National Heart, Lung, and Blood Institute. Low Blood Pressure. (https://www.nhlbi.nih.gov/health-topics/low-blood-pressure) Accessed 8/23/2021.
  • National Center for Biotechnology Information. Physiology, Pulse Pressure. (https://www.ncbi.nlm.nih.gov/books/NBK482408/) Accessed 8/23/2021.
  • Wong ND, Franklin SS. EPIDEMIOLOGY OF HYPERTENSION. (https://accesscardiology.mhmedical.com/content.aspx?sectionid=176572658&bookid=2046#1161727435) In: Fuster V, Harrington RA, Narula J, Eapen ZJ. eds. Hurst's The Heart, 14e. Chap. 23. McGraw Hill. Accessed 8/23/2021.

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