Wide Pulse Pressure in the Elderly

With advancing age the large arteries of the body become more stiff and less compliant, which causes an increase in systolic blood pressure and pulse pressure as well as a decrease in diastolic blood pressure. A perusal of the literature reveals that in the last few years there is ample evidence and multiple publications claiming that a wide pulse pressure, reflecting large artery stiffness, is a significant and at times independent risk factor for cardiovascular disease particularly in the elderly. This article presents a review and a summary of the salient studies and trials conducted in different institutions and countries correlating the increase in pulse pressure with cardiovascular outcomes primarily cardiovascular mortality, coronary artery disease, myocardial infarction, congestive heart failure and stroke. The information available, although mainly consistent, is insufficient to determine if the encountered relationship of wide pulse pressure and cardiovascular events is causal or whether wide pulse pressure is just a marker of an underlying disease. There has been no trial to test the benefit of treating wide pulse pressure. In order to decide if pulse pressure will become clinically useful for the definition and management of hypertension and for cardiovascular risk stratification we will need more research and randomized clinical trials to explore if reversal in coronary risk and cardiovascular complications is obtained with drugs that decrease pulse pressure and if pulse pressure monitoring will be useful for coronary risk stratification.