Editing Pulse pressure

{{short description|Difference between systolic and diastolic blood pressure}}
{{distinguish|Pulse rate|Heart rate}}
{{Infobox medical intervention
 | Name        = Pulse pressure
 | Image       = File:2109_Systemic_Blood_Pressure.jpg
 | Caption     = Pulse pressure variation (PPV) in different arteries and veins
 | ICD10       =
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}}

'''Pulse pressure''' is the difference between [[systole|systolic]] and [[diastole|diastolic]] [[blood pressure]].<ref name="Homan Cichowski 2019">{{cite book | vauthors = Homan TD, Bordes SJ, Cichowski E | chapter = Physiology, Pulse Pressure | date = 12 July 2022 | title = StatPearls [Internet]. | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 29494015 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK482408/ | via = NCBI Bookshelf | access-date = 2019-07-21 }}</ref> It is measured in [[Millimeter of mercury|millimeters of mercury]] (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40&nbsp;mmHg.<ref name="Homan Cichowski 2019"/><ref name="pmid21848774">{{cite journal | vauthors = Liaw SY, Scherpbier A, Klainin-Yobas P, Rethans JJ | title = A review of educational strategies to improve nurses' roles in recognizing and responding to deteriorating patients | journal = International Nursing Review | volume = 58 | issue = 3 | pages = 296–303 | date = September 2011 | pmid = 21848774 | doi = 10.1111/j.1466-7657.2011.00915.x }}</ref> A pulse pressure that is consistently 60&nbsp;mmHg or greater is likely to be associated with disease, and a pulse pressure of 50&nbsp;mmHg or more increases the risk of [[cardiovascular disease]].<ref name="Homan Cichowski 2019"/><ref name="Cleveland Clinic 2021">{{cite web |url=https://my.clevelandclinic.org/health/symptoms/21629-pulse-pressure |title= Pulse pressure  |author=<!--Not stated--> |date=28 July 2021 |publisher=Cleveland Clinic |access-date=10 February 2023 |quote=If you check your blood pressure regularly and notice you have an unusually wide (60&nbsp;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. [...] Pulse pressures of 50&nbsp;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. }}</ref> Pulse pressure is considered low if it is less than 25% of the systolic. (For example, if the systolic pressure is 120&nbsp;mmHg, then the pulse pressure would be considered low if it were less than 30&nbsp;mmHg, since 30 is 25% of 120.)<ref name="pmid21848774"/> A very low pulse pressure can be a symptom of disorders such as [[congestive heart failure]].<ref name="Cleveland Clinic 2021"/>

== Calculation ==
Pulse pressure is calculated as the difference between the systolic blood pressure and the diastolic blood pressure.<ref name="Cleveland Clinic 2021"/><ref>{{cite web | vauthors = Weber CO | date = 24 February 2022 | veditors = Shah A | url = http://highbloodpressure.about.com/od/highbloodpressure101/p/pulse_pressure.htm | archive-url = https://web.archive.org/web/20090217151343/http://highbloodpressure.about.com/od/highbloodpressure101/p/pulse_pressure.htm | archive-date = 17 February 2009 | title = Pulse Pressure | work = about.com }}</ref>

The systemic pulse pressure is approximately proportional to [[stroke volume]], or the amount of blood ejected from the [[Left Ventricle|left ventricle]] during [[systole]] (pump action) and inversely proportional to the [[compliance (physiology)|compliance]] (similar to [[Elasticity (physics)|elasticity]]) of the [[aorta]].<ref>{{cite web | vauthors = Klabunde RE | date = 29 March 2007 | work = Cardiovascular Physiology Concepts| url = http://www.cvphysiology.com/Blood%20Pressure/BP003.htm | archive-url = https://web.archive.org/web/20080516033607/http://www.cvphysiology.com/Blood%20Pressure/BP003.htm | archive-date = 16 May 2008 | title = Arterial pulse pressure }}</ref>

* ''Systemic pulse pressure'' (most commonly measured at the [[brachial artery]] in the upper arm using a [[Sphygmomanometer]]) = {{nobr|P<sub>systolic</sub> − P<sub>diastolic</sub>}}
:e.g. normal 120&nbsp;mmHg – 80&nbsp;mmHg = 40&nbsp;mmHg<ref name="Cleveland Clinic 2021"/>
: low: {{nobr|100&nbsp;mmHg − 80&nbsp;mmHg {{=}} 20&nbsp;mmHg}}
: high: {{nobr|160&nbsp;mmHg − 80&nbsp;mmHg {{=}} 80&nbsp;mmHg}}

* ''Pulmonary pulse pressure'' is normally much lower than systemic blood pressure due to the higher compliance of the pulmonary system compared to the arterial circulation.<ref>{{cite journal | vauthors = Blacher J, Evans A, Arveiler D, Amouyel P, Ferrières J, Bingham A, Yarnell J, Haas B, Montaye M, Ruidavets JB, Ducimetière P | display-authors = 3 | title = Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study | journal = Journal of Human Hypertension | volume = 24 | issue = 1 | pages = 19–26 | date = January 2010 | pmid = 19474798 | doi = 10.1038/jhh.2009.34 | s2cid = 24409022 | author12 = PRIME Study Group | url = https://pure.qub.ac.uk/ws/files/632832/Residual%20cardiovascular%20risk%20in%20treated%20hypertension%20and%20hyperlipidaemia%20-%20the%20PRIME%20Study%20-%20J%20Hum%20Hypertens%202010%20-%20Evans%20AE,%20Yarnell%20JW..pdf }}</ref> It is measured by [[Pulmonary artery catheter|right heart catheterization]] or may be estimated by [[Echocardiography#Transthoracic echocardiogram|transthoracic echocardiography]]. Normal pulmonary artery pressure is 8&nbsp;mmHg–20&nbsp;mmHg at rest.<ref>{{cite journal | vauthors = Parasuraman S, Walker S, Loudon BL, Gollop ND, Wilson AM, Lowery C, Frenneaux MP | title = Assessment of pulmonary artery pressure by echocardiography-A comprehensive review | journal = International Journal of Cardiology. Heart & Vasculature | volume = 12 | pages = 45–51 | date = September 2016 | pmid = 28616542 | pmc = 5454185 | doi = 10.1016/j.ijcha.2016.05.011 | doi-access = free }}</ref>
:e.g. normal 15mmHg – 8mmHg = 7mmHg
:high 25mmHg – 10mmHg = 15mmHg

==Values and variation==

===Low (narrow) pulse pressure ===
A pulse pressure is considered abnormally low if it is less than 25% of the systolic value.<ref name="pmid21848774"/> If the pulse pressure is extremely low, i.e. 25&nbsp;mmHg or less, it may indicate low stroke volume, as in [[congestive heart failure]].<ref name="Cleveland Clinic 2021"/>

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.<ref>{{cite book | location = Chicago, IL | publisher = American College of Surgeons |title= Advanced Trauma Life Support (ATLS) Program for Doctors |year=2008 |pages=58 |isbn=978-1-880696-31-6 }}</ref>

A narrow pulse pressure is also caused by [[aortic stenosis]].<ref name="Cleveland Clinic 2021"/> This is due to the decreased stroke volume in aortic stenosis.<ref name=":0">{{Citation |last1=Homan |first1=Travis D. |title=Physiology, Pulse Pressure |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK482408/ |work=StatPearls |access-date=2023-10-25 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29494015 |last2=Bordes |first2=Stephen J. |last3=Cichowski |first3=Erica}}</ref> 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.<ref name=":0" />

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.<ref> Homan TD, Bordes SJ, Cichowski E (2024), "[https://www.ncbi.nlm.nih.gov/books/NBK482408/ Physiology, Pulse Pressure]", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29494015, archived from the original on 2024-04-21, retrieved 2024-04-22</ref>

=== High (wide) pulse pressure===

==== Consistently high ====
A pulse pressure of 50&nbsp;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.<ref name="Cleveland Clinic 2021"/> There are currently no drugs approved to lower pulse pressure, but some [[antihypertensive drug]]s 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.<ref name="cushman" />

The aorta has the highest compliance in the arterial system due in part to a relatively greater proportion of [[Elastic fiber|elastin fibers]] versus [[smooth muscle]] and [[collagen]]. This serves to dampen the pulsatile [[ejection fraction]] of the [[left ventricle]], thereby reducing the initial systolic pulse pressure, but slightly raising the subsequent diastolic phase. If the aorta becomes rigid, stiff and inextensible because of disorders, such as [[arteriosclerosis]], [[atherosclerosis]] or [[Connective tissue disease|elastin defects]] (in connective tissue diseases), the pulse pressure would be higher due to less compliance of the aorta.<ref>See also: [[Central aortic blood pressure]]</ref>

In hypertensive patients, a high pulse pressure can often be an indicator of [[conduit artery]] stiffness ([[Arterial stiffness|stiffness of the major arteries]]).<ref name="Mitchell Izzo Lacourcière Ouellet 2002 pp. 2955–2961"/> When the arterial walls are stiffer (less compliant), the heart has to beat harder to overcome the resistance from the stiff arteries, resulting in an increased pulse pressure.<ref name="News-Medical.net 2009 f388">{{cite web | title=What is Arterial Stiffness? | website=News-Medical.net | date=23 Nov 2009 | url=https://www.news-medical.net/health/What-is-Arterial-Stiffness.aspx | access-date=18 Nov 2023}}</ref>

Other conditions that can lead to a high pulse pressure include [[aortic regurgitation]],<ref name=Tang2020/> [[aortic sclerosis]], severe [[iron-deficiency anemia]] (due to decreased [[blood viscosity]]), [[arteriosclerosis]] (due to loss of arterial compliance), and [[hyperthyroidism]]<ref name=Tang2020/> (due to increased systolic pressure), or [[arteriovenous malformation]], among others.<ref name=":0" /> In aortic regurgitation, the aortic valve insufficiency results in the backward flow of blood (regurgitation) that is ejected during systole, and its return to the left ventricle during diastole. This increases the systolic blood pressure, and decreases the diastolic blood pressure, leading to a widened pulse pressure.<ref name=":0" /><ref name="Cleveland Clinic 2021" />

A high pulse pressure combined with [[bradycardia]] and an irregular breathing pattern is associated with increased [[intracranial pressure]], a condition called [[Cushing's triad]] seen in people after head trauma with increased intracranial pressure.<ref name="cushing">{{cite book |  vauthors = Dinallo S, Waseem M | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK549801/ | pmid=31747208 | year=2022  | chapter = Cushing reflex | title = StatPearls | location = Treasure Island (FL) | publisher = StatPearls Publishing }}</ref>

Common causes of widening pulse pressure include:<ref name="Cleveland Clinic 2021"/>
* [[Anemia]]
* [[Aortic dissection]]
* [[Atherosclerosis]]<ref name="Tang2020">{{cite journal |last1=Tang |first1=KS |last2=Medeiros |first2=ED |last3=Shah |first3=AD |title=Wide pulse pressure: A clinical review. |journal=Journal of Clinical Hypertension (Greenwich, Conn.) |date=November 2020 |volume=22 |issue=11 |pages=1960–1967 |doi=10.1111/jch.14051 |pmid=32986936 |pmc=8029839 }}</ref>
* [[Arteriovenous fistula]]<ref name=Tang2020/>
* [[Aortic regurgitation|Chronic aortic regurgitation]]
* [[Aortic aneurysm|Aortic root aneurysm]]<ref name="Dilation of the thoracic aorta: med">{{cite journal | vauthors = Nataf P, Lansac E | title = Dilation of the thoracic aorta: medical and surgical management | journal = Heart | volume = 92 | issue = 9 | pages = 1345–1352 | date = September 2006 | pmid = 16908722 | pmc = 1861150 | doi = 10.1136/hrt.2005.074781 }}</ref>
* Aortic root dilation<ref name="Dilation of the thoracic aorta: med"/>
* [[Beri beri]]<ref name=Tang2020/>
* [[Distributive shock]]<ref name=Tang2020/>
* [[Endocarditis]]
* [[Fever]]
* [[Heart block]]
* [[intracranial pressure|Increased intracranial pressure]]<ref name=cushing/><ref name=Tang2020/>
* [[Patent ductus arteriosus]]
* [[Pregnancy]]<ref name=Tang2020/>
* [[Thyrotoxicosis]]<ref name=Tang2020/>

==== From exercise ====
For most individuals, during aerobic exercise, the systolic pressure progressively increases while the diastolic pressure remains about the same, thereby widening the pulse pressure. These pressure changes facilitate an increase in [[stroke volume]] and [[cardiac output]] at a lower [[mean arterial pressure]], enabling greater aerobic capacity and physical performance. The diastolic drop reflects a reduced [[Vascular resistance|systemic vascular resistance]] of the muscle [[arteriole]]s in response to the exercise.<ref name="pmid10373221">{{cite journal | vauthors = Bertovic DA, Waddell TK, Gatzka CD, Cameron JD, Dart AM, Kingwell BA | title = Muscular strength training is associated with low arterial compliance and high pulse pressure | journal = Hypertension | location = Dallas, Texas | volume = 33 | issue = 6 | pages = 1385–91 | date = June 1999 | pmid = 10373221 | doi = 10.1161/01.hyp.33.6.1385 | doi-access = free }}</ref>

== Clinical significance ==
Pulse pressure has implications for both cardiovascular disease as well as many non-cardiovascular diseases. Even in people without other risk factors for cardiovascular disease, a consistently wide pulse pressure remains a significant independent predictor of all-cause, cardiovascular, and, in particular, coronary mortality.<ref name="Benetos Safar Rudnichi Smulyan 1997 pp. 1410–1415">{{cite journal | last1=Benetos | first1=Athanase | last2=Safar | first2=Michel | last3=Rudnichi | first3=Annie | last4=Smulyan | first4=Harold | last5=Richard | first5=Jacques-Lucien | last6=Ducimetière | first6=Pierre | last7=Guize | first7=Louis | title=Pulse Pressure | journal=Hypertension | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=30 | issue=6 | year=1997 | issn=0194-911X | doi=10.1161/01.hyp.30.6.1410 | pages=1410–1415| pmid=9403561 }}</ref> There is a positive correlation between high pulse pressure and markers of inflammation, such as [[c-reactive protein]].<ref name="Abramson Vaccarino 2006 pp. 223–233">{{cite book | last1=Abramson | first1=Jerome L. | last2=Vaccarino | first2=Viola | title=Atherosclerosis, Large Arteries and Cardiovascular Risk | chapter=Pulse Pressure and Inflammatory Process in Atherosclerosis | series=Advances in Cardiology | publisher=KARGER | publication-place=Basel | year=2006 | volume=44 | doi=10.1159/000096733 | pages=223–233| pmid=17075211 | isbn=3-8055-8176-9 }}</ref>

===Cardiovascular disease and pulse pressure===
Awareness of the effects of pulse pressure on morbidity and mortality is lacking relative to the awareness of the effects of elevated systolic and diastolic blood pressure. However, pulse pressure has consistently been found to be a stronger independent predictor of cardiovascular events, especially in older populations, than has systolic, diastolic, or mean arterial pressure.<ref name="Cleveland Clinic 2021"/><ref name="Mitchell Izzo Lacourcière Ouellet 2002 pp. 2955–2961"/> This increased risk has been observed in both men and women and even when no other cardiovascular risk factors are present. The increased risk also exists even in cases in which high pulse pressure is caused by diastolic pressure decreasing over time while systolic remains steady or even slightly decreases.<ref name="Franklin Khan Wong Larson 1999 pp. 354–360">{{cite journal | last1=Franklin | first1=Stanley S. | last2=Khan | first2=Shehzad A. | last3=Wong | first3=Nathan D. | last4=Larson | first4=Martin G. | last5=Levy | first5=Daniel | title=Is Pulse Pressure Useful in Predicting Risk for Coronary Heart Disease? | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=100 | issue=4 | date=27 Jul 1999 | issn=0009-7322 | doi=10.1161/01.cir.100.4.354 | pages=354–360| pmid=10421594 | doi-access=free }}</ref><ref name="Benetos Safar Rudnichi Smulyan 1997 pp. 1410–1415"/>

A [[meta-analysis]] in 2000 showed that a 10&nbsp;mmHg increase in pulse pressure was associated with a 20% increased risk of cardiovascular mortality, and a 13% increase in risk for all coronary end points. The study authors also noted that, while risks of cardiovascular end points do increase with higher systolic pressures, at any given systolic blood pressure the risk of major cardiovascular end points increases, rather than decreases, with lower diastolic levels.<ref name = "pulse pressure not mean">{{cite journal | vauthors = Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L, Wang JG, Fagard RH, Safar ME | display-authors = 6 | title = Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients | journal = Archives of Internal Medicine | volume = 160 | issue = 8 | pages = 1085–1089 | date = April 2000 | pmid = 10789600 | doi = 10.1001/archinte.160.8.1085 | doi-access = free }}</ref> This suggests that interventions that lower diastolic pressure without also lowering systolic pressure (and thus lowering pulse pressure) could actually be counterproductive.<ref name=":0" />

People who simultaneously have a resting diastolic pressure of less than 60 mmHg and a pulse pressure of greater than 60 mmHg have double the risk of subclinical [[myocardial ischaemia]] and a risk of stroke that is 5.85 times greater than normal.<ref name="s321">{{cite journal | last=Spence | first=J David | title=Risk from low blood pressure in frail older adults: diastolic pressure and pulse pressure are important | journal=Age and Ageing | publisher=Oxford University Press (OUP) | volume=50 | issue=6 | date=10 Jun 2020 | issn=0002-0729 | doi=10.1093/ageing/afaa084 | pages=e5–e6}}</ref> For such patients, it may be dangerous to target a peripheral systolic pressure below 120 mmHg due to the fact that this could cause the diastolic blood pressure in the cerebral cortex in the brain to become so low that perfusion (blood flow) is insufficient, leading to [[white matter lesion|white matter lesions]]. Nearly all coronary perfusion and more than half of cerebral perfusion occurs during diastole, thus a diastolic pressure that is too low can cause harm to both the heart and the brain.<ref name="m918">{{cite journal | last=Spence | first=J David | last2=Müller | first2=Lucas O | last3=Blanco | first3=Pablo J | title=How to identify which patients should not have a systolic blood pressure target of &amp;lt;120 mmHg | journal=European Heart Journal | publisher=Oxford University Press (OUP) | volume=43 | issue=6 | date=11 Sep 2021 | issn=0195-668X | doi=10.1093/eurheartj/ehab552 | pages=538–539}}</ref>

Increased pulse pressure is also a risk factor for the development of [[atrial fibrillation]].<ref name="staerk">{{cite journal |vauthors=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH |title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes |journal=Circulation Research |volume=120 |issue=9 |pages=1501–1517 |date=April 2017 |pmid=28450367 |pmc=5500874 |doi=10.1161/CIRCRESAHA.117.309732 |url=}}</ref>

===Effects of medications on pulse pressure===
There are no drugs currently approved to lower pulse pressure. Although some anti-hypertensive drugs currently on the market may have the effect of modestly lowering pulse pressure, others may actually have the counterproductive effect of increasing pulse pressure. Among classes of drugs currently on the market, a 2020 review stated that [[thiazide diuretics]] and long‐acting [[Nitrate#Medicine|nitrates]] are the two most effective at lowering pulse pressure.<ref name=Tang2020/>

It has been hypothesized that vasopeptidase inhibitors and [[nitric oxide donors]] may be useful at lowering pulse pressure in patients with elevated pulse pressure by increasing the distensibility of the large arteries.<ref name = "pulse pressure not mean"/><ref name="Mitchell Izzo Lacourcière Ouellet 2002 pp. 2955–2961">{{cite journal | last1=Mitchell | first1=Gary F. | last2=Izzo | first2=Joseph L. | last3=Lacourcière | first3=Yves | last4=Ouellet | first4=Jean-Pascal | last5=Neutel | first5=Joel | last6=Qian | first6=Chunlin | last7=Kerwin | first7=Linda J. | last8=Block | first8=Alan J. | last9=Pfeffer | first9=Marc A. | title=Omapatrilat Reduces Pulse Pressure and Proximal Aortic Stiffness in Patients With Systolic Hypertension | journal=Circulation | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=105 | issue=25 | date=25 Jun 2002 | issn=0009-7322 | doi=10.1161/01.cir.0000020500.77568.3c | pages=2955–2961| pmid=12081987 | s2cid=7092379 }}</ref> There is evidence that [[glyceryl trinitrate]], a nitric oxide donor, may be effective at lowering both pulse pressure and overall blood pressure in patients with acute and sub-acute stroke.<ref name="Gray Sprigg Rashid Willmot 2006 j585">{{cite journal | last1=Gray | first1=LJ | last2=Sprigg | first2=N | last3=Rashid | first3=PA | last4=Willmot | first4=MR | last5=Bath | first5=PM | title=Effect of nitric oxide donors on blood pressure and pulse pressure in acute and subacute stroke | journal=Journal of Stroke and Cerebrovascular Diseases | publisher=Centre for Reviews and Dissemination (UK) | date=2006 | volume=15 | issue=6 | pages=245–249 | doi=10.1016/j.jstrokecerebrovasdis.2006.06.002 | pmid=17904083 | url=https://www.ncbi.nlm.nih.gov/books/NBK73056/ | access-date=18 Nov 2023}}</ref> 

A 2001 randomized, placebo-controlled trial of 1,292 males, compared the effects of [[hydrochlorothiazide]] (a [[thiazide diuretic]]), [[atenolol]] (a [[beta-blocker]]), [[captopril]] (an [[ACE inhibitor]]), [[clonidine]] (a central [[alpha-2 agonist|α{{sub|2}}-agonist]]), [[diltiazem]] (a [[calcium channel blocker]]), and [[prazosin]] (an [[Alpha-1 blocker|α{{sub|1}}-blocker]]) on pulse pressure and found that, after one year of treatment, hydrochlorothiazide was the most effective at lowering pulse pressure, with an average decrease of 8.6&nbsp;mmHg. Captopril and atenolol were equal as least effective, with an average decrease of 4.1&nbsp;mmHg. Clonidine (decrease of 6.3&nbsp;mmHg), diltiazem (decrease of 5.5&nbsp;mmHg), and prazosin (decrease of 5.0&nbsp;mmHg) were intermediate.<ref name="cushman">{{cite journal |last1=Cushman |first1=William C. |last2=Materson |first2=Barry J. |last3=Williams |first3=David W. |last4=Reda |first4=Domenic J. |date=1 Oct 2001 |title=Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial |journal=Hypertension |volume=38 |issue=4 |pages=953–957 |doi=10.1161/hy1001.096212|pmid=11641316|s2cid=19241872 |doi-access=free }}</ref>

===Pulse pressure and sepsis===
Diastolic blood pressure falls during the early stages of [[sepsis]], causing a widening of pulse pressure. If sepsis becomes severe and [[hemodynamic]] compromise advances, the systolic pressure also decreases, causing a narrowing of pulse pressure.<ref name=pedsepsis>{{cite journal |vauthors=Khilnani P, Singhi S, Lodha R, Santhanam I, Sachdev A, Chugh K, Jaishree M, Ranjit S, Ramachandran B, Ali U, Udani S, Uttam R, Deopujari S |date=January 2010 |title=Pediatric Sepsis Guidelines: Summary for resource-limited countries |journal=Indian J Crit Care Med |volume=14 |issue=1 |pages=41–52 |doi=10.4103/0972-5229.63029 |pmc=2888329 |pmid=20606908 |doi-access=free }}</ref> A pulse pressure of over 70&nbsp;mmHg in patients with sepsis is correlated with an increased chance of survival. A widened pulse pressure is also correlated with an increased chance that someone with sepsis will benefit from and respond to [[Fluid replacement#Intravenous|IV fluids]].<ref name=widesepsis>{{cite journal |vauthors=Al-Khalisy H, Nikiforov I, Jhajj M, Kodali N, Cheriyath P |date=11 December 2015 |title=A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis. |journal=J Community Hosp Intern Med Perspect |volume=5 |issue=6 |page=29426 |doi=10.3402/jchimp.v5.29426 |pmc=4677588 |pmid=26653692 }}</ref>

== See also ==
* [[Cold pressor test]]
* [[Prehypertension]]
* [[Patent ductus arteriosus]]
* [[Windkessel effect]]

== References ==
{{Reflist}}
{{Cardiovascular physiology}}

{{DEFAULTSORT:Pulse Pressure}}
[[Category:Blood pressure]]
[[Category:Medical signs]]
[[Category:Cardiovascular physiology]]