Dr. Chung- Question on "Pulse Pressure" 
Author Message
 Dr. Chung- Question on "Pulse Pressure"

Dr. Chung, I have some questions referencing one of the articles on your
"A Cardiologist's Anwers" page.  Regarding wide "pulse pressure"--

"...physiologically a wide pulse pressure can be caused by rapid
dissipation of the systolic pressure by healthy large vascular beds in
highly conditioned individuals (champion marathon runners often have
pulse pressures >65 mmHG)..."

My question is does this effect mean that a highly conditioned athlete
with high pulse pressure would have a very low diastolic pressure ?
Assuming a normal desired BP is 120/80, using the above would a highly
conditioned athlete have a pressure of 120/55 ?  Or would both
systolic and diastolic pressures tend to be lower ?

I have read that "stroke volume" of the heart increases with aerobic
conditioning.  Wouldn't  this tend to increase systolic pressure ?  If
true, this would contradict the usual recommendation for exercise to
lower {*filter*} pressure, but of course there are probably multiple variables
resulting in decreased {*filter*} pressure.

Regards,
Greg



Fri, 23 Jul 2004 13:23:41 GMT
 Dr. Chung- Question on "Pulse Pressure"

Quote:

> Dr. Chung, I have some questions referencing one of the articles on your
> "A Cardiologist's Anwers" page.  Regarding wide "pulse pressure"--

> "...physiologically a wide pulse pressure can be caused by rapid
> dissipation of the systolic pressure by healthy large vascular beds in
> highly conditioned individuals (champion marathon runners often have
> pulse pressures >65 mmHG)..."

> My question is does this effect mean that a highly conditioned athlete
> with high pulse pressure would have a very low diastolic pressure ?

Not very low but should be lower.

Quote:

> Assuming a normal desired BP is 120/80, using the above would a highly
> conditioned athlete have a pressure of 120/55 ?

Such an athlete could have a pressure of 120/55 and this pressure in such an
individual would not be considered abnormal.  However, in a sedentary elderly
person, we would worry about a stiffened aorta with reduced "capacitance"
being the cause of the higher systolic minus diastolic difference.

Quote:
> Or would both
> systolic and diastolic pressures tend to be lower ?

If both were lower, the "pulse pressure" would be less.

Quote:

> I have read that "stroke volume" of the heart increases with aerobic
> conditioning.  Wouldn't  this tend to increase systolic pressure ?

Yes.

Quote:
> If
> true, this would contradict the usual recommendation for exercise to
> lower {*filter*} pressure, but of course there are probably multiple variables
> resulting in decreased {*filter*} pressure.

But, the decrease in peripheral vascular resistance is greater so that the
net effect is a lower pressure at rest.

Good questions.

--
Dr. Andrew B. Chung, MD/PhD
Atlanta Cardiologist
http://www.***.com/



Sat, 24 Jul 2004 00:45:11 GMT
 Dr. Chung- Question on "Pulse Pressure"

Quote:
> Dr. Chung, I have some questions referencing one of the articles on your
> "A Cardiologist's Anwers" page.  Regarding wide "pulse pressure"--

> "...physiologically a wide pulse pressure can be caused by rapid
> dissipation of the systolic pressure by healthy large vascular beds in
> highly conditioned individuals (champion marathon runners often have
> pulse pressures >65 mmHG)..."

> My question is does this effect mean that a highly conditioned athlete
> with high pulse pressure would have a very low diastolic pressure ?
> Assuming a normal desired BP is 120/80, using the above would a highly
> conditioned athlete have a pressure of 120/55 ?  Or would both
> systolic and diastolic pressures tend to be lower ?

> I have read that "stroke volume" of the heart increases with aerobic
> conditioning.  Wouldn't  this tend to increase systolic pressure ?  If
> true, this would contradict the usual recommendation for exercise to
> lower {*filter*} pressure, but of course there are probably multiple variables
> resulting in decreased {*filter*} pressure.

Trying to analyse the BP of marathon runners is indeed a conundrum. How
about this real case study.

Home and surgery {*filter*} pressure (more or less) -- 140-155/90-95
With 75 mg irbesartan --  120/80
Within half hour or so after two hour training run  85-90/50-55  !
Without irbesartan after training run -- 95-100/55-60

(Veteran athlete with low cholesterol and in good health.)

To treat or not?    ;-).

Paul R



Sat, 24 Jul 2004 18:51:29 GMT
 Dr. Chung- Question on "Pulse Pressure"
What are normal pulse prressure limits for an 47 year old male?Is it as
in {*filter*} pressure the lower the better?


Sun, 25 Jul 2004 07:53:38 GMT
 Dr. Chung- Question on "Pulse Pressure"

Quote:

> What are normal pulse prressure limits for an 47 year old male?Is it as
> in {*filter*} pressure the lower the better?

Lower the better *without* symptoms.  However, there is no real way to low
the pulse pressure except with medications that will lower *both* the
systolic and diastolic pressures with the net effect being minimal.

--
Dr. Andrew B. Chung, MD/PhD
Atlanta Cardiologist
http://www.***.com/



Sun, 25 Jul 2004 08:45:56 GMT
 Dr. Chung- Question on "Pulse Pressure"

Quote:

> Trying to analyse the BP of marathon runners is indeed a conundrum. How
> about this real case study.

> Home and surgery {*filter*} pressure (more or less) -- 140-155/90-95
> With 75 mg irbesartan --  120/80
> Within half hour or so after two hour training run  85-90/50-55  !
> Without irbesartan after training run -- 95-100/55-60

> (Veteran athlete with low cholesterol and in good health.)

> To treat or not?    ;-).

Would treat *but* first choice would have been an ACE inhibitor which has been
proven (as a class) to reduce CAD risk.

--
Dr. Andrew B. Chung, MD/PhD
Atlanta Cardiologist
http://www.***.com/



Sun, 25 Jul 2004 09:04:51 GMT
 Dr. Chung- Question on "Pulse Pressure"
Would pulse pressure of 20 (without symptoms) be considered normal?What
are symptoms of low pulse pressure?


Sun, 25 Jul 2004 14:33:50 GMT
 
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