Biomarkers · Cardiac & Hemodynamics

Pulse Pressure

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 11% higher risk of death. We found the same pattern in NHANES

Pulse Pressure and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.11×95% CI 1.08–1.13 · 49,318 adults, 7,264 deaths

Published risk of death1.09×per 10 mm Hg pulse pressure increment (95% CI 1.07–1.11) · Meta-analysis of 14 prospective observational studies in the general population (510,456 participants)

Value of the measurement+0.007gain in concordance within age bands; rank 47 of 56 · all tests

Across studies, risk per SD1.11×NHANES 1.11 [1.08–1.13] · HRS 1.09 [1.07–1.12]

Pulse Pressure across cohorts

11.1HR per SD (95% CI)

NHANES · United States, 20–8449,318 people · 7,264 deaths1.11 1.08–1.13

HRS · United States, 50+24,148 people · 8,515 deaths1.09 1.07–1.12

Risk-of-death ratio per standard deviation, adjusted for age and sex, within each cohort. Cohorts differ in age range, assay, measurement protocol and follow-up, and one SD is a different amount in each, so the comparison is of direction and rough size per SD, not per unit. Vertical line: no association.

Pulse Pressure by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mmHg), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	28.7	37.3	43.3	51.0	63.3	1,449	NHANES 2017-2018
All	40-59	30.7	38.7	44.7	53.3	74.7	1,576	NHANES 2017-2018
All	60+	37.3	50.0	60.0	73.3	101	1,923	NHANES 2017-2018
All	all	30.7	40.0	47.3	58.7	84.7	4,948	NHANES 2017-2018
Men	20-39	30.7	39.3	45.6	53.8	65.1	704	NHANES 2017-2018
Men	40-59	30.7	38.0	44.7	52.0	69.9	744	NHANES 2017-2018
Men	60+	36.0	48.0	58.0	70.0	90.7	980	NHANES 2017-2018
Men	all	31.3	40.0	48.0	58.0	78.7	2,428	NHANES 2017-2018
Women	20-39	28.7	36.0	41.3	47.3	58.3	745	NHANES 2017-2018
Women	40-59	30.0	38.7	45.3	54.7	79.3	832	NHANES 2017-2018
Women	60+	39.3	52.0	62.7	78.7	106	943	NHANES 2017-2018
Women	all	30.7	40.0	47.3	59.3	90.7	2,520	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in Pulse Pressure, study by study

3 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
behavioral	12-month multimedia e-counseling programme for self-care (exercise, diet, adherence, smoking) in adults with hypertension	Pulse pressure -5.2 mmHg (95% CI -6.9 to -3.5) vs -2.7 mmHg (95% CI -4.5 to -0.9) with control at 12 months (P=0.04)	RCT	Nolan RP, et al. Circ Cardiovasc Qual Outcomes. 2018. Randomized Controlled…
nutraceutical	Celery (Apium graveolens) seed extract capsules, 1.34 g/day for 4 weeks, in adults with hypertension	24-h ambulatory pulse pressure fell from 49.0 to 45.8 mmHg after 4 weeks (p < .01); no significant change on placebo	RCT	Shayani Rad M, et al. Phytother Res. 2022. Effect of celery (Apium graveolens)…
pharmacologic	Sacubitril/valsartan titrated to 200 mg twice daily for 18 months in asymptomatic adults with pre-heart failure with preserved ejection fraction	Ambulatory pulse pressure change -4.2 mmHg (95% CI -7.2 to -1.21) vs -1.2 mmHg with valsartan	RCT	Ledwidge M, et al. JAMA Cardiol. 2023. Effect of Sacubitril/Valsartan vs…

Sources

Risk curve: Zhao 2014 (PMID 25052820): all-cause RR 1.09 (1.07-1.11) per 10 mm Hg pulse pressure increment. Scaled to US values (NHANES).
Zhao et al. Brachial pulse pressure and cardiovascular or all-cause mortality in the general population: a meta-analysis of prospective observational studies. Journal of clinical hypertension (Greenwich, Conn.). 2014;16:678-85.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Pulse Pressure against another biomarker.

Map Pulse Pressure against another marker