Widened Pulse Pressure - Differential Diagnosis and Pathophysiology



Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure.

Pulse Pressure = Systolic Blood Pressure - Diastolic Blood Pressure

“Widened” PP is defined as >100 mm Hg although PP should always be considered in the context of the patient’s absolute SBP and DBP.



Pulse Pressure = Stroke Volume / Arterial Aompliance



Physiologic Causes:

 • Advanced age-arteriosclerosis (less compliant arteries)

 • Pregnancy

 • Well-conditioned athletes



Pathologic Causes:

 • Valvular disorders:

	- Aortic regurgitation

	- Aortic sclerosis (both heart valve conditions)

 • Severe iron deficiency anemia (reduced blood viscosity)

 • Hyperdynamic circulation/High output heart failure:

	- Hyperthyroidism/Thyrotoxicosis

	- Wet Beriberi

	- Obesity

	- Cirrhosis (Hyperdynamic circulation)

	- Erythroderma

	- Myeloproliferative disorders

	- Chronic pulmonary diseases

 • Arteriovenous fistula - Such as patent ductus arteriosus or peripheral arteriovenous malformations

 • Sympathetic overdrive

 • Elevated Intracranial Pressure

 • Vasoplegia

 • Sepsis



Complications of Widened Pulse Pressure:

 • Pulse pressure - associated with an increased risk of developing atrial fibrillation

 • Mitchell et al. showed that patients with a pulse pressure greater than 61 mmHg developed atrial fibrillation at a rate of 23.3%

 • Wide PP and systolic hypertension had a significantly positive association with coronary heart disease

 • Increased risk for stroke

 • Worse outcomes in CKD



Differential Diagnoses:

 • Acute Coronary Syndrome

 • Blunt Abdominal Trauma

 • Heart Failure

 • Infective Endocarditis

 • Mitral Regurgitation

 • Mitral Stenosis

 • Myocardial Infarction

 • Pulmonary Regurgitation (Pulmonic Regurgitation)

 • Tricuspid Stenosis



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