Management of Wide Pulse Pressure

Understanding Wide Pulse Pressure

Wide pulse pressure reflects arterial stiffness and increased left ventricular afterload, reducing coronary perfusion pressure through decreased diastolic pressure, generally >50-55 mmHg in the general population, and ≥60 mmHg in dialysis patients 2, 1
The European Society of Hypertension and American Heart Association recommend against using pulse pressure for treatment decisions, reserving it for additional risk stratification in elderly patients with systolic hypertension 1

Target systolic BP <140 mmHg and diastolic BP <90 mmHg in patients without proteinuria or chronic kidney disease 3
Target systolic BP ≤130 mmHg and diastolic BP ≤80 mmHg in patients with diabetes mellitus or chronic kidney disease 2

In elderly patients with wide pulse pressure and isolated systolic hypertension, lowering systolic BP may cause diastolic BP to fall below 60 mmHg, requiring careful monitoring for myocardial ischemia and worsening heart failure 1
In patients over age 60 with diabetes or heart failure, avoid lowering diastolic BP below 60 mmHg despite elevated systolic pressure 1
In dialysis patients with pulse pressure >60 mmHg and systolic BP >135 mmHg, reduce pulse pressure to target of 40 mmHg through achieving ideal body weight and antihypertensive medication 1
Pulse pressure >60 mmHg in dialysis patients carries an 8% increase in relative mortality risk per mmHg increment 1

ACE inhibitors and ARBs have their antialbuminuric effects augmented by dietary salt restriction and diuretic therapy 3

Regularly inquire about symptoms suggesting postural hypotension, particularly in elderly patients with osteoporosis where falls pose significant risk 3
Monitor for electrolyte abnormalities and medication side effects during treatment intensification 3

Wide pulse pressure is a risk factor for biphasic anaphylaxis (OR 2.11, 95% CI 1.32-3.37) and should prompt extended clinical observation in a setting capable of managing anaphylaxis 4