Although current guidelines for the management of high blood pressure (BP) rest almost completely on the measurement of systolic (top) and diastolic (bottom) blood pressure, a new study has found that something known as the "pulse pressure" may actually be a better predictor of heart disease risk.

The pulse pressure is the difference between the systolic and diastolic pressures. For example someone with a blood pressure of 120/80 has a pulse pressure of 40.

This study was a meta-analysis combining the results of several studies, including nearly 8,000 elderly patients.

A 10-mm Hg increase in pulse pressure was found to increase the risk of major cardiovascular complications and mortality by nearly 20%

The authors contend that this association of pulse pressure to risk of heart disease helps to explain the apparent elevations in risk associated with low diastolic pressure.

The authors of the study note that some high blood pressure medications may actually increase the pulse pressure. For example, if someone has an elevated BP of 150/95 (pulse pressure = 55) and medication brings it down to 140/80 (pulse pressure = 60), then according to this study's findings, this person may actually be at GREATER risk of heart disease than before.

Pulse pressure is usually high with a condition known as aortic regurgitation, and low with aortic stenosis.

Arch Intern Med. 2000;160:1085-1089