Narrow pulse pressure

[Theresa]

I was wondering if anybody has had narrow pulse pressure or found anything that helps with it? I am feeling really bad at present and I think this may be the reason. I was also wondering if it is something a GP would know about or not?

 

[Jonathan Edwards]

What do you mean by a narrow pulse pressure exactly?

 

[Theresa]

What do you mean by a narrow pulse pressure exactly?

I think it means the difference between systolic and diastolic blood pressure being less than 25% of sysystolic as described below

https://www.potsuk.org/low-pulse-pressure/

 

[Jonathan Edwards]

I think it means the difference between systolic and diastolic blood pressure as described below

Yes, that is what it means- I was wondering what numbers you were referring to though?
I am not aware that it is supposed to relate to any symptoms, although it can be a silent sign of specific conditions.

 

[Theresa]

Yes, that is what it means- I was wondering what numbers you were referring to though?
I am not aware that it is supposed to relate to any symptoms, although it can be a silent sign of specific conditions.

Thank you, my blood pressure is 93/74 today and I can't stand up much without feeling faint and feel very unwell sitting as well with chest tightness and general weakness and shakiness, so I thought that might be the cause as I have noticed a correlation in the past.

 

[Jonathan Edwards]

I don't think pulse pressure is itself a problem. 93 is on the low side, which might be.
Low pulse pressure can be a sign of a structural valve problem but if so it doesn't usually vary.
I cannot advise specifically but if you are unwell probably best to consult the GP.

 

[Hoopoe]

I was wondering if anybody has had narrow pulse pressure or found anything that helps with it?

I had this for a while together with orthostatic intolerance.

Do you have orthostatic intolerance? Have you tried treating it?

Do you have small fiber neuropathy?

 

[Theresa]

I had this for a while together with orthostatic intolerance.

Do you have orthostatic intolerance? Have you tried treating it?

Do you have small fiber neuropathy?

I have something like POTS diagnosed from standing up and I take a low dose beta blocker and lots of salt. I probably don't have small fibre neuropathy based on symptoms but I haven't had tests for it.

 

[Hutan]

I've talked about low pulse pressure in ME/CFS before. I think it is a clue.

I'd like to promote pulse pressure and shock index as measures to be thought about. On bad days in the months that I measured lots of things, I would have low pulse pressure and high shock index.

That said, I don't want to detract from the need to get the symptoms you mention checked out with your GP.

 

[Hutan]

Venous insufficiency and acrocyanosis in long COVID: dysautonomia, 2023, Iftekhar & Sivan
This is a Long Covid case study where blood pressure sitting and standing was noted, but the narrow pulse pressure (as calculated from the BPs) was not noted.

Low pulse pressure on standing makes me wonder about Systrom's preload failure findings.

 

[Hutan]

Narrow pulse pressure has been reported in at least several papers from different teams e.g.

From the Discussion, on pulse pressure:

Abnormally narrowed pulse pressures occur in several diseases including heart failure (decreased pump effectiveness), blood loss, (decreased blood volume), aortic stenosis (reduced stroke volume), and cardiac tamponade (decreased filling time) and are due to decreases in systolic pressures while diastolic pressures remain stable (Homan et al., 2022). In contrast, we found that the narrow PP in PASC and < 4 year ME/CFS cohorts was due to a rise in DBP with relatively stable SBP. The mechanistic basis for the elevated DBP and narrowing pulse pressure during the orthostatic challenge is not clear for PASC but we hypothesize it may be a physiologically adaptive mechanism designed to mitigate the physiological stress of hemodynamic challenge. Research on ME/CFS patients indicates hemodynamic changes during orthostatic or exercise challenge results in reduced ventricular filling caused by the peripheral circulatory changes rather than primary cardiopulmonary perturbation (Lee et al., 2020; Singh et al., 2022).

There have been two reports of abnormally narrowed PP due to increased DBP in PASC and ME/CFS patients (van Campen and Visser, 2022; Vernon et al., 2022)

And here's another post from me about my tracking of cardiovascular measures showing the variability and association with worse symptoms:

I tracked this [reaction time measure] as part of symptom monitoring for about a month, measuring it in the morning, missing some days, maybe 5 years ago.

For example, my best score was 307. On that day, my morning resting heart rate was 65, my morning shock index (0.7), pulse pressure (36) and POTS standing test (19) were all normal. Morning resting BP was 110 over 68;standing BP increased to 120 over 84. I did a grocery shop that day. The next day was an average day.

My worst score was 459. On that day, my morning resting heart rate was 64, my morning shock index was very abnormal - 1.08. Pulse pressure was very abnormal - 23. The POTS standing test was positive for POTS (41). Morning resting BP was lowish (102 over 63) and it got worse upon standing for 10 minutes (97 over 74). I think all those measures add up to the heart and brain not getting enough blood when I was upright. But - I didn't record it as a PEM day. I did a bit of gardening. The next day was a bad PEM day though.

My second worst score was 431. Morning resting heart rate was 63, morning shock index 0.9 (a bit high), pulse pressure normal (32), POTS positive (35). Morning resting BP was lowish 104/63; standing BP was 106/74. It wasn't a bad day. The next day was an average day.

 

[Theresa]

Thanks for the helpful information @Hutan , did you find anything that helped with pulse pressure apart from the general things like pacing and time?

 

[Hutan]

did you find anything that helped with pulse pressure apart from the general things like pacing and time?

I haven't monitored things for a while - full on measuring and symptom recording takes quite a bit of effort and is rather joy-sapping. So, I can't say anything specifically about pulse pressure. With symptoms in general, no, apart from, as you say, managing activity to try not to cause PEM.

I did notice that I would get extremely low pulse pressures (coupled with feeling bad) with prolonged standing e.g. standing to wash dishes or to chop vegetables. So, I do try to sit to do some of those jobs, or break the standing into short bursts (and of course use a dishwasher for most things). And sit or lie down afterwards to recover quickly. Moving around while standing might also help.

Oh, I should have said earlier, thanks Theresa for making the thread. As you can probably tell, this topic is a bit of a hobby horse of mine. It's an objective measure and seems like a clue to pathophysiology.

 

[ahimsa]

Some more data just in case it's helpful.

I was a regular blood donor in the 1980s when I was healthy. They used to measure the blood pressure of each donor and would not let anyone donate blood if the pulse pressure was too low.

My memory is that they didn't do a calculation, e.g., some percentage of systolic blood pressure. I think they just wouldn't let people donate if the pulse pressure was below 25. Both my blood pressure and my pulse pressure were often quite low, even though I was healthy and active with no symptoms, but my pulse pressure was never too low to give blood.

The folks who were doing the blood donations (American Red Cross) said the reason they rejected donors with low pulse pressure had something to do with blood volume and not being able to spare enough blood to donate. (I may not be wording this correctly)