Understanding High Pulse Pressure: Causes & Concerns

A blood pressure reading of 120/60 mmHg means the systolic pressure is 120 mmHg and the diastolic pressure is 60 mmHg, resulting in a pulse pressure of 60 mmHg (120 - 60 = 60). This is considered a wide pulse pressure, since normal pulse pressure is typically between 40 and 60 mmHg.

A high pulse pressure (widened difference) like 60 mmHg or more can be caused by several physiological and pathological factors. Here are the main causes:

🔹 1. Stiffness of Arteries (Reduced Arterial Compliance)

• Most common cause, especially in older adults.
• As people age, arteries (especially the aorta) become stiffer due to atherosclerosis or arteriosclerosis.
• Stiff arteries can't absorb the pressure surge from each heartbeat effectively, leading to higher systolic pressure.
• During diastole, blood flows out more quickly, causing lower diastolic pressure.
• Result: ↑ Systolic, ↓ Diastolic → ↑ Pulse Pressure

🔹 2. Aortic Regurgitation (Valvular Heart Disease)

• The aortic valve doesn’t close properly, allowing blood to leak back into the left ventricle during diastole.
• This increases the volume ejected during systole (↑ systolic pressure) and lowers the pressure during diastole (↓ diastolic pressure).
• Classic sign: Wide pulse pressure, "water-hammer" pulse.

🔹 3. Anemia

• Increased cardiac output to compensate for reduced oxygen-carrying capacity.
• Leads to higher systolic pressure due to increased stroke volume.
• Diastolic pressure may remain normal or drop slightly.
• Common in severe or chronic anemia.

🔹 4. Hyperthyroidism

• Increased metabolism → increased heart rate and cardiac output.
• Vasodilation in peripheral arteries → lower diastolic pressure.
• Systolic pressure may rise due to higher stroke volume.
• Net effect: Widened pulse pressure.

🔹 5. Fever

• Increases heart rate and cardiac output.
• Peripheral vasodilation reduces diastolic pressure.
• Can transiently increase pulse pressure.

🔹 6. Arteriovenous (AV) Fistula

• Abnormal connection between artery and vein.
• Decreases systemic vascular resistance and increases cardiac output.
• Can cause a significant rise in pulse pressure.

🔹 7. Severe Hypertension (especially isolated systolic hypertension)

• Common in elderly: systolic pressure is high, but diastolic may be normal or low.
• Often due to stiff arteries.

🔹 8. Pregnancy (in some cases)

• Increased cardiac output and reduced systemic vascular resistance.
• May lead to modestly increased pulse pressure, usually not concerning unless extreme.

🔹 9. Age-Related Changes

• With aging, the aorta loses elasticity.
• This is the primary reason older adults often have isolated systolic hypertension and wide pulse pressure.

⚠️ When to Be Concerned?

A pulse pressure of 60 mmHg is at the upper limit of normal. While occasionally seen in healthy individuals, especially during exercise or in athletes, consistently high pulse pressure may indicate:

• Early cardiovascular disease
• Increased risk of heart attack, stroke, or heart failure
• Aortic valve issues

📊 Summary: Causes of High Pulse Pressure (e.g., 120/60)

Cause	Mechanism
Arterial stiffness	↑ Systolic, ↓ Diastolic
Aortic regurgitation	Backflow lowers diastolic, high stroke volume raises systolic
Anemia	↑ Cardiac output → ↑ systolic
Hyperthyroidism	↑ Output + vasodilation → ↑ pulse pressure
Fever	Similar to hyperthyroidism
AV fistula	Shunt reduces diastolic, increases systolic
Aging	Loss of aortic elasticity

✅ What Should You Do?

If you or someone has a consistently wide pulse pressure:

• Consult a healthcare provider.
• Evaluate for heart valve disease, anemia, thyroid issues, or vascular stiffness.
• Consider an echocardiogram if aortic regurgitation is suspected.
• Monitor blood pressure regularly.

✅ Occasional wide pulse pressure may be normal, but persistent widening should be evaluated.