SBP − DBP. Wide pulse pressure flags arterial stiffness.
Source: Dart & Kingwell, JACC 2001.
What does pulse pressure mean?
Pulse pressure is the difference between systolic blood pressure (the peak pressure during heart contraction) and diastolic blood pressure (the pressure during heart relaxation). It is calculated as simply SBP − DBP. A typical resting blood pressure of 120/80 mmHg gives a pulse pressure of 40 mmHg.
Pulse pressure reflects the compliance (elasticity) of the large arteries, particularly the aorta. When the heart pumps, it creates a wave of pressure. Healthy, elastic arteries absorb much of this wave, keeping the diastolic pressure elevated and the pulse pressure moderate. As arteries stiffen with age or disease, they absorb less of the wave: systolic pressure rises and diastolic pressure may fall, widening the pulse pressure.
Elevated pulse pressure (above 60 mmHg) is a well-established independent predictor of cardiovascular mortality, particularly in adults over 60. It is strongly associated with coronary artery disease, stroke, left ventricular hypertrophy, and renal impairment. Research from the Framingham Heart Study and subsequent meta-analyses consistently demonstrates that pulse pressure predicts cardiovascular events better than either systolic or diastolic pressure alone in older adults.
A narrow pulse pressure (below 25 mmHg) can indicate heart failure with reduced ejection fraction, severe aortic stenosis, or significant hypovolaemia, all serious conditions.
Reference ranges
| Category | Pulse Pressure (mmHg) | Interpretation |
|---|---|---|
| Low / narrow | < 25 | May indicate reduced cardiac output |
| Normal | 25 – 40 | Healthy arterial compliance |
| Mildly elevated | 41 – 60 | Mild arterial stiffness |
| Wide / elevated | > 60 | Significant arterial stiffness; increased CVD risk |
When should you see a doctor?
A persistently wide pulse pressure (above 60 mmHg) or a narrow pulse pressure (below 25 mmHg) should be evaluated by a doctor. Wide pulse pressure in younger adults may prompt investigation for secondary hypertension or aortic valve disease. In older adults it is often part of isolated systolic hypertension management. A single reading may not mean much on its own; pulse pressure should be assessed over several measurements taken in a calm, resting state.
Frequently asked questions
What is a normal pulse pressure?
A normal pulse pressure is generally 40 mmHg (the typical difference between a systolic of 120 and diastolic of 80). A pulse pressure below 25 mmHg may indicate reduced cardiac output. A pulse pressure above 60 mmHg is considered wide and is associated with arterial stiffness and increased cardiovascular risk.
What causes wide pulse pressure?
Wide pulse pressure (above 60 mmHg) is primarily caused by arterial stiffness, the loss of elasticity in the aorta and large arteries that normally cushion the pulse wave. Arterial stiffness increases with age, chronic hypertension, diabetes, and atherosclerosis. Other causes include aortic regurgitation (valve disease), severe anaemia, and hyperthyroidism.
Is pulse pressure a better predictor of heart disease than systolic or diastolic BP?
In older adults (over 60), pulse pressure is a stronger predictor of cardiovascular events than either systolic or diastolic pressure alone. The Framingham Heart Study showed that for people over 60, each 10 mmHg increase in pulse pressure was associated with a 10–15% increase in cardiovascular event risk. In younger adults, diastolic pressure tends to be a stronger risk factor.