Pulse pressure draws new attention as a heart and dementia risk marker

Doctors are paying closer attention to pulse pressure, a number derived from a standard blood pressure reading that can reflect the condition of the arteries. Researchers cited by NBC News say elevated pulse pressure is linked to cardiovascular risk and may also be tied to dementia-related death in some people.

Pulse pressure is the difference between the systolic reading, the top number, and the diastolic reading, the bottom number. Dr. Charles Hong, chair of medicine at Michigan State University’s College of Human Medicine, told NBC News that the measure can offer a view of artery flexibility, with higher values often pointing to stiffer blood vessels.

What the number means

In a blood pressure reading of 120/80 millimeters of mercury, the pulse pressure is 40. NBC News reported that 40 mm Hg is considered normal for adults.

The systolic number reflects pressure in the arteries when the heart contracts and pushes blood through the body. The diastolic number reflects arterial pressure between heartbeats.

Hong said pulse pressure can rise during exercise and tends to widen with age as systolic pressure increases and diastolic pressure falls. He also said a persistent reading above 40 mm Hg may be concerning.

The Mayo Clinic says pulse pressure above 60 mm Hg can be a heart disease risk, especially among older adults. A 2023 National Library of Medicine text cited by NBC News describes pulse pressure above 100 mm Hg as high.

Research from the Framingham Heart Study found that each 10 mm Hg rise in pulse pressure was associated with a 23% higher risk of coronary artery disease, according to NBC News. Hong said very low pulse pressure can also be a problem because it may indicate the heart is not generating enough force to move blood; a pulse pressure below 25% of systolic pressure is considered low.

New dementia findings

A study published June 3 in the journal Neurology examined data from the REGARDS study at the University of Alabama at Birmingham, according to NBC News. REGARDS includes more than 30,000 U.S. adults age 45 and older and oversamples Black participants, who are more likely than white peers to die of stroke.

Geneticist Laura Raffield of the University of North Carolina School of Medicine and her colleagues studied nearly 9,000 participants with an average age of 64. The researchers calculated genetic risk scores for 11 cardiometabolic conditions and risk factors, including high pulse pressure, atrial fibrillation and cholesterol levels.

After 14 years, more than 450 participants had died from dementia-related causes. NBC News reported that people with a higher genetic risk score for elevated pulse pressure had a 16% greater risk of dementia-related death, while the other studied conditions and risk factors did not show a statistically significant association.

Raffield told NBC News the findings do not rule out roles for other genetic or clinical risks. She said pulse pressure may provide added information in older adults about arterial stiffness, cardiovascular function and blood flow in the brain.

Dr. Steven Nissen, chief academic officer at the Cleveland Clinic’s Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, was not involved in the study. He told NBC News that the connection between pulse pressure and brain health is expected, though more research is needed to confirm the genetic link.

How doctors address it

Nissen said treating high blood pressure also lowers pulse pressure. He recommended the DASH eating plan, which emphasizes foods low in sodium and saturated and trans fats and higher in fiber, protein, calcium, magnesium and potassium.

NBC News also cited regular exercise as a way to lower blood pressure. Hong said keeping pulse pressure under control may help protect heart and brain health over time.

This story draws on original reporting from NBC News.