Pulse pressure: what the gap between your blood pressure values reveals
There is more between 160/80 and 118/78 than just a high upper value. The gap between the two numbers – the pulse pressure – says something about your blood vessels that neither value shows on its own.
Your blood pressure monitor shows two numbers. Almost all guides focus on the upper one. Yet there is a third value that is not on any display, but which you can work out in your head – and which has interested cardiologists for decades.
Pulse pressure = upper value minus lower value. At 118 over 78 that is 40. At 160 over 80 it is 80. In the second case, both people have a raised upper value – but the vascular situation behind it is fundamentally different.
What pulse pressure actually describes
Every heartbeat ejects blood into the aorta. The upper value (systolic) is the pressure peak at that moment. The lower value (diastolic) is the pressure that remains between two beats while the heart refills.
The gap between them depends on two things: how much blood the heart ejects per beat and how elastic the large blood vessels are.
A young, elastic aorta works like an air chamber (Windkessel): it stretches with each heartbeat, absorbs part of the pressure peak and releases it again during the pause. This caps the peak and keeps the pressure up between beats. The gap stays small.
If this vessel becomes stiffer over the years, the buffer is lost. The pressure peak comes through in full, the upper value rises – and because the recoil force is missing, the lower value often even falls. The gap becomes larger. That is exactly why many older people see 165 over 75 on the display and not 165 over 105.
Why this does not lead to age-dependent normal values is explained in Blood pressure table by age: what really applies.
Which values are typical
In healthy adults, pulse pressure is usually between about 40 and 50 mmHg. It rises slowly with age; this is normal and is not a finding in itself.
It becomes interesting at both ends:
- Persistently above 60 mmHg, especially over the age of 60, is regarded in large observational studies as an indication of stiffened large vessels and is statistically associated with a higher cardiovascular risk.
- Very small, roughly below 25 to 30 mmHg, can mean that little blood arrives per heartbeat – for example in severe heart failure, a narrowed aortic valve or major fluid loss.
Important, so that no false impression arises here: these are statistical associations at population level, not diagnoses. A single pulse pressure of 62 initially means nothing at all for you personally. Meaning only comes from many measurements over time – and from assessment by someone who knows the rest of your situation.
Why a single value will mislead you
Pulse pressure inherits all the measurement errors of both underlying values – twice over. A cuff that is too loose, an arm below heart level, talking during the measurement: each of these errors shifts the systolic and diastolic values to different degrees and thus changes the difference.
Then there is natural fluctuation. Blood pressure changes continuously with the rhythm of breathing; two measurements two minutes apart regularly give different numbers without anything being wrong. We have described this in detail in Why your blood pressure is different every time you measure it.
Practical consequence: never calculate pulse pressure from a single measurement, but from the average of a week of measurements.
Pulse pressure changes – you just don't see it
Your pulse pressure is not a fixed number. It changes with every heartbeat, with breathing, with the moment. A cuff measurement takes a single snapshot out of this entire course – and the very snapshot you want to see is usually already over by the time you have put the device on.
This is exactly where a blood pressure event recorder works differently from a blood pressure monitor.
Conventional blood pressure monitor
ResultTwo numbers
TimingWhenever you remember
Pulse pressureA single gap
TechnologyOscillometric single measurement
BPER blood pressure event recorder
ResultThe entire pulse-pressure course, beat by beat
TimingIn the 60 seconds in which you feel something
Pulse pressureHow the gap changes over the course
TechnologyBeat-to-beat recording
Class IIa medical device · no subscription · 30-day right of return
How to determine your pulse pressure sensibly
- Measure twice each morning and evening for seven days – after five minutes of rest, seated, cuff at heart level. The most common sources of error are listed in Measuring blood pressure correctly: 7 mistakes that distort your readings.
- Write down every value – including the inconvenient ones.
- Leave out the first day of measurement (familiarisation effect) and calculate the average of the rest separately for systolic and diastolic.
- Subtract one average from the other. That is your pulse pressure.
A prerequisite that is often overlooked: all this requires a device tested according to DIN EN ISO 81060-2 and a cuff of the right size. How to recognise this is explained in Which blood pressure monitor is the most accurate?
When you should take it to your doctor
Bring your week of measurements with you if any of the following applies:
- The averaged gap is persistently above 60 mmHg
- The averaged gap is persistently below 30 mmHg
- The gap has changed significantly compared with earlier measurements
- Symptoms occur as well: shortness of breath on exertion, dizziness, tightness in the chest, a drop in performance, swollen ankles
Sudden shortness of breath, chest pain or fainting is not a reason for an appointment but an emergency – call the emergency services on 112.
What pulse pressure cannot do
It does not replace an examination. Whether large vessels are actually stiffened, whether a valve is narrowed, whether heart failure is present – that is clarified by ultrasound, ECG and laboratory values, not by a subtraction on a notepad.
And it says nothing about your medication. Adjusting blood pressure medication to achieve a certain difference is not a sensible goal – it is people who are treated, not numbers. Do not change anything about ongoing treatment on your own.
The real point
Pulse pressure is instructive because it shows that two numbers contain more than two pieces of information. The upper value alone makes 160 over 80 and 160 over 110 the same case. They are not.
If you keep a blood pressure diary, you already have this third number at home – it just needs to be calculated. The fact that pressure, pulse and rhythm are three observations of the same process is summarised on Pulse, pressure, rhythm.
If you want to see what happens between the two numbers: the BPER blood pressure event recorder records the pulse-pressure course in 60 seconds – beat by beat.
How to describe your symptoms so your doctor can actually work with them
Five steps for your next doctor’s appointment – plus a printable template for noting down your observations.
This is how it usually sounds
“I felt strange again last night. A kind of stumble, and it gave me a fright.”
“Let’s keep an eye on it.”
The guide shows you how to describe it instead and which questions to ask. What is usually missing are the numbers from exactly those two minutes – and those are what the BPER records, beat by beat.
Frequently asked questions
How do I calculate pulse pressure?
Subtract the lower value from the upper value. At 135 over 85, the pulse pressure is 50 mmHg. However, the number only becomes meaningful when you calculate it from the averages of a seven-day series of measurements rather than from a single measurement.
When is pulse pressure too high?
Values that average persistently above 60 mmHg are regarded, especially from the age of 60, as an indication of stiffened large vessels. This is a statistical association from population studies and not a diagnosis – the assessment belongs in your doctor's surgery.
What does a very small gap between the values mean?
An averaged pulse pressure below about 25 to 30 mmHg can mean that little blood is ejected per heartbeat, for example in severe heart failure, a narrowed aortic valve or major fluid loss. If shortness of breath, dizziness or a drop in performance occur as well, you should have this checked by a doctor.
Why has my lower value become lower with age?
When the large vessels stiffen, the recoil force that maintains the pressure between two heartbeats is missing. The upper value then rises while the lower value stays the same or falls – the gap becomes larger. This is a common pattern and a reason to have your values assessed by a doctor.
What is a blood pressure event recorder?
A blood pressure event recorder continuously records the course of blood pressure and pulse over a short period of time, instead of capturing a single value. It is intended for the moments when you feel something – not as a replacement for regular measurement.
Is a normal blood pressure monitor enough to assess pulse pressure?
For the rough range, yes: upper value minus lower value can be calculated from any measurement. What a single value does not show is how this gap changes over a course.
Which device shows pulse pressure over a course?
This requires beat-to-beat recording, i.e. a measurement beat by beat instead of a single snapshot. The BPER blood pressure event recorder is a Class IIa medical device that does exactly that for home use.
How far apart may systolic and diastolic be?
A gap of about 40 to 60 mmHg is considered the usual range. Persistently well above this is regarded, especially in older age, as an indication of stiffer arteries; persistently below about 30 mmHg as an indication of low ejection output. A single value says nothing about this – only the repeated course is meaningful. Only your doctor can assess it.
What is more important, blood pressure or pulse pressure?
They describe different things and do not replace each other. The two blood pressure values tell you how high the pressure is overall. Pulse pressure tells you how large the difference between ejection and relaxation is. In studies, pulse pressure gains in significance mainly from about the age of 60 – as a supplement, not a replacement.
Which pulse pressure at which age?
There are no fixed age limits. Over the years the large arteries lose elasticity; as a result, the upper value often rises while the lower value stays the same or falls – the gap becomes larger. A gap that is conspicuous in a 40-year-old may be unremarkable in a 75-year-old. What matters is the change over time, not the comparison with a table.
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This article is for general information only and does not replace a medical diagnosis or treatment. If you have symptoms or questions about your treatment, please consult your doctor.