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Pulse pressure—a review of mechanisms and clinical relevance

^a Alfred Baker Medical Unit, Alfred Hospital and Baker Medical Research Institute, Melbourne, Australia

View larger version (23K): [in a new window]   Figure 1 Pulse pressure (PP) arises from the interaction between stroke volume (SV) and the characteristics of the arterial circulation that determine compliance (C) and wave reflection. As discussed in the text, wave reflection occurs at multiple sites but is shown in the diagram as a single site for the sake of simplicity. Cardiac output and peripheral vascular resistance (PVR) determine mean arterial pressure (MAP).

View larger version (17K): [in a new window]   Figure 2 Schematic diagram illustrating the concept of bidirectionality in the relationship between pulse pressure (PP) and atherosclerosis. Elevated PP promotes vascular damage, an antecedent to atherosclerosis, which results in large-vessel stiffening and increased wave reflection, thus, further amplifying PP. While it is not clear which is the incipient event in this cycle, it is clear that, once initiated, a vicious cycle promoting disease progression ensues.