A person unaware of medicine, when he hears the term pulse pressure, does not always understand what is being said. After all, there is blood pressure, which is measured by a special device with a tonometer. It is necessary to understand the specifics of cardiological terminology.
The magnitude of the pulse pressure is closely related to the results obtained in determining blood pressure. As everyone knows, when measuring it, 2 values are taken into account. The first indicator is systolic pressure. It reflects the maximum amount of pressure that the heart creates, contracting and pushing blood through the vascular bed. The second number is diastolic and shows the total amount of pressure that occurs in the arterial vessels in the time period between contractions of the heart. They are expressed in millimeters of mercury.
The difference between systolic and diastolic values is pulse pressure. In the medical literature, blood pressure is referred to as BP, and pulse pressure – PD. In a healthy person, the blood pressure at rest should correspond to 120/80 millimeters of mercury, then the pulse indicator will be 40 mm Hg. Art. This value is considered to be normative when diagnosing cardiac pathology.
However, the indicator 40 is an ideal value, which according to theoretical data should not deviate in any direction by more than 5 units. In fact, in a healthy young man, the pulse pressure can vary from 30 to 50 mm Hg. Art. And this will not be considered a pathology. However, a larger or smaller gap between diastole and systole will be a symptom of the pathology of the cardiovascular system, even if the upper blood pressure is normal.
Knowing that the pulse pressure is normally a value of 40 mm Hg. Art. Having data from this indicator in a patient, an experienced cardiologist is more likely to:
- predict the state of the vascular bed;
- determine its permeability;
- determine the state of the arterial walls;
- to identify the presence of foci of the inflammatory process or stenosis.
That is, only on the basis of measuring blood pressure will be able to make a preliminary diagnosis.
Even in a physiologically healthy person, pulse pressure can rise. The reason for this are heavy exercise. However, normally this indicator should be restored when a person is at rest within 10 minutes.
When diagnosing cardiac pathology, the focus is precisely on the high value of pulse pressure. Numerous studies and testing of groups of volunteers gave the right to assume: the higher the value of PD, the higher the risk of death of the patient from the pathology of the cardiovascular system even in the case when the diagnosis of arterial hypertension in history is absent.
It turned out that an increase in this value above the permissible values at rest and at minimum load, as a rule, is associated with structural pathologies in the region of the heart and blood vessels. However, not only this can cause a change in the indicator. It is noticed that the reasons for high pulse pressure can be the following:
- 1. Various pathologies of the aortic valve of the heart.
- 2. Congenital defects in the structure of blood vessels, for example, the presence of an abnormal vessel connecting the aorta and the pulmonary artery.
- 3. Anemic conditions, in particular, caused by a lack of iron ions in the body.
- 4. Various pathological processes that are accompanied by the appearance of arteriovenous fistula: Paget’s disease, skin fistula in dermatitis, liver cirrhosis. Moreover, the size, number and localization of the fistula does not play a special role.
- 5. Pulse pressure often rises during pregnancy. Moreover, the entire area of the placenta actually plays the role of a large venous arterial fistula.
- 6. Various febrile states.
- 7. Thyrotoxicosis.
- 8. Renal failure.
Why the pulse pressure increases in case of diseases of the heart and blood vessels is still not clear. Experts suggest that this is due to an increase in the rigidity of the vessels of the circulatory system. At the same time, it does not matter, the systolic or diastolic blood pressure is changed. The most unfavorable formative factor is the decrease in the elasticity of large vessels, for example, the aorta or large arteries. As a rule, this can occur in patients with pronounced hypertension or atherosclerotic changes in the region of the walls of these vessels.
Often, patients are diagnosed with low pulse pressure. Moreover, in contrast to the increased PD, besides the fact that it may be below the norm (less than 30 mmHg), its ratio to systolic pressure is also taken into account. In this case, the pathology is any value of PD, which is less than systole by at least 25% or even lower. What does it mean? Arithmetic is very simple: for example, the patient has a systolic pressure of an average of 140 mm Hg. Art., then the lower rate of pulse pressure for him will be no longer 30, but 35%. Anything less than this value will be considered a sign of pathology.
Reducing the difference between systole and diastole is not even included in the system, and manifested by single attacks, almost always accompanied by characteristic clinical symptoms. The patient when going to the doctor complains of constant weakness and apathy. He tends to sleep. The efficiency is lowered, since it is difficult for a person to concentrate while performing even a simple task. Often worries headache, which appears for no apparent reason. With a more severe course, dizziness and loss of consciousness are detected.
Not only an increase in pulse pressure, but also a sharp decrease in pressure always causes concern to the attending physicians, especially if this indicator is below the permissible mark of 30 mmHg. Art. As a rule, this phenomenon is caused by a malfunction of the heart. Therefore, if during the diagnostics a decrease in pulse pressure is detected, the patient is immediately sent to the functional diagnostics department, and if there is none, then he will be consulted by an experienced cardiologist.
What can be diagnosed when conducting such a survey?
- 1. Quite often, a sharp decline in PD occurs as a result of the development of cardiogenic shock. In this case, low pulse pressure is a signal of weakening of cardiac activity. The cause may be stenosis of the aortic mouth, which ultimately leads to a decrease in the volume of blood ejected from the heart. Due to the fact that the lumen of the aorta is reduced, hypertrophic changes occur in the muscle tissue of the left ventricle. It is they that lead to the development of myogenic dilatation of the heart. Clinically, this is manifested by a decrease in systolic, respectively, and pulse pressure. But this is not the only heart disease that is manifested by a drop in PD. It actually signals a decrease in the amount of cardiac output, as a result, can be detected in patients with heart attacks and severe post-infarction conditions, as well as inflammatory processes in the area of cardiac muscle of various genesis.
- 2. But not only about the violation of the work of the heart this indicator warns. Pulse pressure decreases in case of development of the ischemic state of the kidneys as a result of the inflammatory process. The reason for the decrease in PD is an increase in the production of the specific hormone renin. In turn, reducing the difference in systolic and diastolic blood pressure indicator makes it even more difficult to filter the blood in the kidney tissues.
- 3. A sharp decrease in PD is characteristic of the development of hypovolemic shock. It is caused by a decrease in blood volume in the bloodstream, for example, after an injury that is accompanied by massive bleeding. The cause of the shock can be an overabundance of the hormone renin. It causes a sharp narrowing of the blood vessels, which prevents blood from moving along them.
What is the danger of lowering the pulse pressure for the patient? As a rule, it indicates the development of irreversible processes in the human body, for example, in the area of brain tissue, foci of atrophic changes are formed, the visual perception or respiration process is disturbed (paralysis of the respiratory function).
In any case, the pathological process is formed gradually, but at a certain stage it becomes uncontrollable and simply ceases to be amenable to drug correction.
For the patient, this is fatal.
It can be concluded that the pulse pressure reflects not only the state of the cardiovascular system, but practically all the main human organs and systems. Monitoring of this indicator should be periodically carried out by each person, even one who considers himself completely healthy. And patients with pathology of the cardiovascular system should do this regularly, simultaneously with the measurement of blood pressure. Modern pharmaceutical industry has facilitated this procedure by releasing a special electronic device. Unlike a classical tonometer, all data of systolic and diastolic indicators are carried out on the monitor screen. Using them, you can easily calculate the PD.