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Review
. 2020 Nov;22(11):1960-1967.
doi: 10.1111/jch.14051. Epub 2020 Sep 28.

Wide pulse pressure: A clinical review

Kevin S Tang  1 , Edward D Medeiros  1   2   3 , Ankur D Shah  1   2   3
Affiliations
Review

Wide pulse pressure: A clinical review

Kevin S Tang et al. J Clin Hypertens (Greenwich). 2020 Nov.

Abstract

Pulse pressure naturally increases over time as individuals' age due to arteriosclerosis and diffuse vascular stiffening. However, the differential for widened pulse pressure is broad and includes causes of hyperdynamic circulation and high-output heart failure, such as aortic regurgitation and hyperthyroidism. In the absence of an underlying cause, wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risk for mortality, disease progression, and adverse clinical outcomes in chronic diseases including cardiovascular disease and chronic kidney disease. Current emphasis of antihypertensive treatment on systolic and diastolic blood pressure does not always address pulse pressure, thus subjecting many patients to an independent risk factor for poor outcomes. Pulse pressure control is more successfully achieved with thiazide diuretics and long-acting nitrates when compared to other antihypertensive agents, but further research is needed to quantify the additional benefits of pulse pressure control over conventional blood pressure therapy. This case review provides an overview of the pathogenesis, pathologic causes, and treatment of widened pulse pressure and evaluates current evidence for pulse pressure as a predictor of clinical outcomes.

Keywords: clinical management of high blood pressure; general; hypertension; vascular disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pathophysiology of age‐related wide pulse pressure
Figure 2
Figure 2
Management of wide pulse pressure
See this image and copyright information in PMC

References

    1. Homan T, Cichowski E. Physiology, pulse pressure. In: StatPearls [Internet]: Treasure Island, FL: StatPearls Publishing; 2019. - PubMed
    1. Pastor‐Barriuso R, Banegas J, Damian J, Appel L, Guallar E. Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. 2003;139(9):731. - PubMed
    1. Franklin SS, Gokhale SS, Chow VH, et al. Does low diastolic blood pressure contribute to the risk of recurrent hypertensive cardiovascular disease events? Hypertension. 2015;65(2):299‐305. - PMC - PubMed
    1. Lorenzo C, Aung K, Stern M, Haffner S. Pulse pressure, prehypertension, and mortality: the San Antonio heart study. Am J Hypertens. 2009;22(11):1219. - PubMed
    1. Franklin SS, Khan S, Wong ND, Larson M, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation. 1999;100(4):354‐360. - PubMed

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