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A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. [2] If the pulse pressure is extremely low, i.e. 25 mmHg or less, it may indicate low stroke volume, as in congestive heart failure. [3] The most common cause of a low (narrow) pulse pressure is a drop in left ventricular stroke volume.
If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. [2] Eighty percent of people with systolic hypertension are over the age of 65 years old. [3] Isolated systolic hypertension is a specific type of widened (or high) pulse pressure.
One can hear it at the left lower sternal border. One may also hear it at the right lower sternal border (when associated with a dilated aorta). Other possible exam findings are bounding carotid and peripheral pulses. These are also known as Corrigan's pulse or Watson's water hammer pulse. Another possible finding is a widened pulse pressure.
The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by high blood pressure. [81] Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension.
In the heart, increased arterial stiffness, increased systolic blood pressure, and widened pulse pressures, all resulting from chronic hypertension, can cause significant damage. Coronary perfusion pressures are decreased by these factors, which also increase myocardial oxygen consumption, possibly leading to left ventricular hypertrophy .
Pulse pressure is considered low if it is less than 25% of the systolic. (For example, if the systolic pressure is 120 mmHg, then the pulse pressure would be considered low if it is less than 30 mmHg, since 30 is 25% of 120.) [91] A very low pulse pressure can be a symptom of disorders such as congestive heart failure. [52]
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Pulsus paradoxus, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke volume, systolic blood pressure (a drop more than 10 mmHg) and pulse wave amplitude during inspiration. Pulsus paradoxus is not related to pulse rate or heart rate, and it is not a paradoxical rise in systolic pressure.