Pulse Pressure (PP) of 90 mmHg: What Does It Mean?

Michael Rotman, MD, FRCPC, PhD | Medically reviewed by Robin Backlund, BHSc
Last update: February 27, 2024

What Is Pulse Pressure?

Pulse pressure is crucial in understanding cardiovascular health, defined as the difference between systolic and diastolic blood pressure readings. Pulse pressure reflects the force the heart generates each time it contracts.

It is a cardiovascular metric that provides insight into the health and elasticity of the arteries, thus serving as an early indicator of cardiovascular diseases.

Since pulse pressure must be read in accordance with other health indicators, it is not a common measurement tool like blood pressure, and there are no official guidelines from AHA, Mayo Clinic, CDC, or WHO.

A 1997 study published in Hypertension by a team of researchers from the State University of New York is by far one of the best references for pulse pressure. According to the study, the various pulse pressure ranges are as follows.

A high pulse pressure indicates a significant drop in pressure between the heart’s contraction and relaxation phases, often pointing to stiffening in the arteries (arteriosclerosis) or other cardiovascular issues, while a low pulse pressure indicates a decrease in stroke volume of blood.

Variations in pulse pressure can occur even minutes apart due to factors like changes in body position, stress, hydration levels, and heart rhythm.

These fluctuations are normal and reflect the dynamic nature of our cardiovascular system responding to different stimuli.

Pulse pressure distinguishes itself from blood pressure, which represents the force exerted by blood flowing through blood vessels against their walls both during and after each heartbeat.

While blood pressure readings consider both the systolic and diastolic pressures to assess overall cardiovascular health, pulse pressure specifically measures the gap between these two, offering additional insights into arterial elasticity and heart function.

Now that you know what pulse pressure is let us learn how to calculate it, and it is very simple! Read more below.

How do you calculate pulse pressure?

Calculating pulse pressure is a simple yet informative process. According to Dr. Francisco Lopez-Jimenez, M.D. from Mayo Clinic, it involves subtracting the diastolic blood pressure from the systolic blood pressure.

Pulse Pressure (PP) = Systolic Blood Pressure (SBP) − Diastolic Blood Pressure (DBP)

The systolic pressure is the top number in a blood pressure reading, indicating the pressure in the arteries when the heart beats.

The diastolic pressure, the bottom number, represents the pressure in the arteries when the heart is at rest between beats.

For example, if someone has a blood pressure reading of 120/80 mmHg, their pulse pressure would be:

PP = 120 − 80 = 40 mmHg

There are no alternative formulas for calculating pulse pressure directly from blood pressure readings.

However, various factors and conditions that influence systolic and diastolic blood pressure can indirectly affect the calculation of pulse pressure.

These include arterial stiffness, blood volume pumped by the heart (stroke volume), the speed at which the pulse wave moves through the circulatory system (pulse wave velocity), and the timing of the reflected waves from the peripheral vasculature.

A deeper understanding of pulse pressure is crucial to monitoring cardiovascular health and identifying potential risks, and below, you will learn more about it.

What Does A Wide Pulse Pressure Mean?

According to Mayo Clinic, a wide pulse pressure refers to a larger-than-normal difference between the systolic and diastolic blood pressure readings.

It is an important indicator in assessing the condition of the cardiovascular system, particularly the elasticity and function of the arterial walls.

In a healthy adult, the pulse pressure should ideally range between 40 and 50 mmHg. When the pulse pressure exceeds this range, it is considered wide or high, signifying that the heart is working under conditions that may not be optimal.

The significance of a wide pulse pressure extends beyond the numbers themselves. It is a reflection of the dynamic interplay between the heart’s pumping action and the resistance it encounters in the blood vessels.

For example, a PP of 90 mmHg indicates changes in the arterial system often encountered as difficulty in pumping blood around, which may be caused by decreased elasticity, which is often associated with aging or other pathological conditions.

Understanding wide pulse pressure involves recognizing its role as both a diagnostic and prognostic tool.

It can help identify individuals at higher risk of cardiovascular events, guiding further diagnostic evaluations and monitoring for doctors for an effective treatment.

Although it is not considered independently and requires interpretation alongside other clinical observations and risk elements, broad pulse pressure remains a pivotal factor in the comprehensive evaluation of cardiovascular well-being.

When a wide pulse pressure persists, you might exhibit a lot of symptoms, which could be early warning signs pointing toward cardiovascular risks. Let us learn more about the symptoms below.

What are the symptoms of wide pulse pressure?

Wide pulse pressure may not always present with noticeable symptoms. However, when symptoms are evident, they often relate to the underlying strain on the cardiovascular system and can include a range of manifestations.

Some common symptoms, as hinted in the 2020 publication “Wide pulse pressure: A clinical review,” are given below.

• Headaches: Individuals with wide pulse pressure might experience headaches due to the increased force of blood flow.
• Dizziness or lightheadedness: Dizziness or feelings of lightheadedness can also occur, reflecting fluctuations in blood pressure and the effect on cerebral circulation.
• Palpitations: A sensation of the heart beating too hard or too fast may arise as the heart compensates for the altered vascular dynamics associated with wide pulse pressure.
• Fatigue: Fatigue is another symptom that can be associated with wide pulse pressure, as the efficiency of blood circulation is impacted, potentially affecting oxygen and nutrient delivery to tissues.
• Shortness of breath: In some cases, shortness of breath might be experienced, especially during physical exertion, as the heart and lungs work harder to meet the body’s demands.

While not specific to a pulse pressure of 90 mmHg, these symptoms can signal that the cardiovascular system is operating under stress, prompting further investigation into the heart’s function and arterial health.

Identifying and correlating these symptoms is crucial for the early detection and management of cardiovascular disorders. The next section will give you a good idea of some of the causes of wide pulse pressure.

What are the causes of wide pulse pressure?

Major causes of wide pulse pressure shall be attributed to comorbidities. A 2022 STATPearl publication by Prof. Travis D. Homan and colleagues speaks about the pathophysiology of wide pulse pressure.

Atherosclerosis

• According to them, one primary cause is arterial stiffness, where the arteries lose their elasticity, often due to aging or atherosclerosis.
• This stiffness prevents arteries from properly cushioning the pulse of blood each time the heart beats, leading to a higher systolic pressure and often a normal or lower diastolic pressure.

Aortic valve regurgitation

• Another significant cause is aortic valve regurgitation, a condition where the aortic valve does not close tightly, allowing blood to flow backward into the heart.
• This increases the volume of blood the heart must pump with each beat, raising systolic pressure and widening the pulse pressure.

Hyperthyroidism

• Conditions that increase blood volume or cardiac output, such as hyperthyroidism, can also cause wide pulse pressure.
• In hyperthyroidism, the excess thyroid hormone increases heart rate and the volume of blood the heart pumps, contributing to a wider gap between systolic and diastolic pressures.

Congenital heart conditions

• Additionally, certain congenital heart defects that affect the heart’s structure and function may lead to wide pulse pressure by altering the flow of blood through the heart and vessels, impacting the pressure dynamics between the beats.

These causes highlight the importance of cardiovascular health and the need for monitoring and managing conditions that can lead to wide pulse pressure.

While the numbers by itself won’t imply a meaning to a layman, a wide pulse pressure could come with potential risks or dangers, as elaborated in the next section.

What are the risks and dangers of wide pulse pressure?

Cardiovascular problems and damage to the kidneys and other vital organs are some of the risks associated with a pulse pressure of 90 mmHg.

In a 2009 publication in the American Journal of Hypertension, Prof. Carlos Lorenzo speaks about the clinical manifestations of wide pulse pressure and its association with increased cardiovascular-related mortalities.

According to the study, a consistently wide pulse pressure, especially in the range of 90, can be indicative of increased cardiovascular risk.

This condition is associated with an elevated likelihood of developing heart diseases, including heart attack and heart failure.

The underlying mechanism involves the increased stress on the heart and blood vessels due to the higher systolic pressure, which can lead to damage over time.

Moreover, wide pulse pressure has been linked to a higher risk of stroke. The elevated pressure generated by the high systolic reading has the potential to harm the fragile blood vessels within the brain, resulting in cerebrovascular incidents.

This risk is compounded by the fact that wide pulse pressure can reflect arterial stiffness, a condition that reduces the arteries’ ability to absorb the pulsatile flow of blood, thereby increasing the strain on cerebral vessels.

Apart from these direct cardiovascular hazards, wide pulse pressure is also linked to a heightened likelihood of kidney disease.

The kidneys’ delicate filtration system can be damaged by the fluctuations in pressure, affecting their ability to filter blood effectively.

This spectrum of risks underscores the importance of monitoring pulse pressure as part of a comprehensive approach to cardiovascular health, aiming to identify and mitigate these dangers before they manifest into more serious conditions.

While wide pulse pressure might be a problematic condition to have, there are several treatment strategies for it, as described in the next section.

How do you treat wide pulse pressure?

Treating wide pulse pressure involves addressing the underlying conditions that contribute to it and implementing strategies to improve arterial health.

When it comes to a pulse pressure of 90 mmHg, consider consulting your doctor to be safer side.

2017 ACC/AHA Guidelines have clearly demonstrated and reported various strategies to manage blood pressure, which is the best way to regulate wide pulse pressure as well.

The treatment strategy is comprehensive, with the goal of minimizing the chances of cardiovascular complications and enhancing arterial flexibility.

Lifestyle modifications

• First and foremost, lifestyle adjustments are pivotal in addressing wide pulse pressure.
• These modifications encompass dietary changes, emphasizing a heart-healthy diet comprising ample fruits, vegetables, whole grains, and lean proteins while restricting sodium, saturated fats, and cholesterol intake.
• Engaging in regular physical activity is also advocated to bolster heart strength and enhance cardiovascular efficiency.
• Managing body weight is crucial, as obesity can exacerbate the condition.
• Moreover, reducing alcohol consumption and quitting smoking are imperative steps, given their adverse effects on blood pressure and arterial health.

Pharmacological treatments

• In some cases, pharmacological interventions may be necessary, depending on the individual’s health status and the severity of wide pulse pressure.
• Commonly prescribed medications include antihypertensives such as ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics.
• These medications aid in lowering systolic blood pressure or enhancing arterial elasticity, thus narrowing the pulse pressure gap.

Monitoring and reporting

• Regular monitoring and management are paramount, with routine check-ups facilitating adjustments to the treatment regimen as required.
• Make sure you use clinically valid products like Oxiline Pressure X Pro, Checkme BP2, Omron Silver, etc.
• Maintain a consistent relationship with your doctor since it is indispensable for effectively managing wide pulse pressure and mitigating associated risks.