Pulse pressure
Pulse pressure
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Pulse pressure

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Pulse pressure

Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 mmHg. A pulse pressure that is consistently 60 mmHg or greater is likely to be associated with disease, and a pulse pressure of 50 mmHg or more increases the risk of cardiovascular disease. Pulse pressure is considered low if it is less than 25% of the systolic. (For example, if the systolic pressure is 120 mmHg, then the pulse pressure would be considered low if it were less than 30 mmHg, since 30 is 25% of 120.) A very low pulse pressure can be a symptom of disorders such as congestive heart failure.

Pulse pressure is calculated as the difference between the systolic blood pressure and the diastolic blood pressure.

The systemic pulse pressure is approximately proportional to stroke volume, or the amount of blood ejected from the left ventricle during systole (pump action) and inversely proportional to the compliance (similar to elasticity) of the aorta.

A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. If the pulse pressure is extremely low, i.e. 25 mmHg or less, it may indicate low stroke volume, as in congestive heart failure.

The most common cause of a low (narrow) pulse pressure is a drop in left ventricular stroke volume. In trauma, a low or narrow pulse pressure suggests significant blood loss.

A narrow pulse pressure is also caused by aortic stenosis. This is due to the decreased stroke volume in aortic stenosis. Other conditions that can cause a narrow pulse pressure include blood loss (due to decreased blood volume), and cardiac tamponade (due to decreased filling time). In the majority of these conditions, systolic pressure decreases, while diastolic pressure remains normal, leading to a narrow pulse pressure.

In the Postural Orthostatic Tachycardia Syndrome it is postulated that declining venous return reduces stroke volume and frequently results in low pulse pressure. In extreme cases, patients experience a drop in pulse pressure to 0 mm Hg upon standing, rendering them practically pulseless while upright. This condition leads to significant morbidity, as many affected individuals struggle to remain standing.

A pulse pressure of 50 mmHg or more can increase the risk of heart disease, heart rhythm disorders, stroke and other cardiovascular diseases and events. Higher pulse pressures are also thought to play a role in eye and kidney damage from diseases such as diabetes. There are currently no drugs approved to lower pulse pressure, but some antihypertensive drugs have been shown to modestly lower pulse pressure, while other drugs used for hypertension can actually have the counterproductive side effect of increasing resting pulse pressure.

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