Take a recent blood pressure reading and subtract the bottom number from the top one — say, 145 minus 80 gives you 65. That figure has a name: pulse pressure. Your blood pressure monitor doesn’t display it directly, but it’s hiding between the two numbers you already have, and different videos online have been citing wildly different thresholds (40, 60), leaving people with perfectly normal blood pressure needlessly worried. (Based on the insights of Dr. Alberto Sanagustín)
Key Takeaways
- Pulse pressure (top number minus bottom number) is cited by the 2023 European hypertension guideline as an arterial stiffness criterion at 60+ mmHg in people over 60 with hypertension — not a universal cutoff or diagnosis.
- Guidelines disagree on how much weight to give this number — the 2025 American guideline doesn’t include it as a criterion or treatment target at all.
- The gap widens with age because systolic pressure tends to rise over time while diastolic pressure plateaus and then gradually declines — a largely normal aging pattern, not a disease.
- Identical pulse pressure numbers can reflect very different situations (e.g., 140/80 vs. 180/120 both give a gap of 60) — the actual two numbers matter more than their difference.
- No guideline treats pulse pressure itself as a treatment target — treatment addresses the two underlying numbers, not the subtraction between them.
What Counts as “Too Much” Difference?
The 2023 European Society of Hypertension guidelines list a pulse pressure of 60 mmHg or more, in people over 60, as one of the criteria for arterial stiffness. That’s a real, specific clinical reference point — but it’s not a universal cutoff for everyone, for three reasons that rarely get mentioned. First, age: that threshold applies to people over 60; in younger people, the gap is naturally smaller, and the same limit doesn’t apply the same way. Second, context: the guideline uses this figure specifically when evaluating people who already have hypertension — it’s not a general classification for the whole population. Third, the word “criterion” itself: a stiffness criterion isn’t a diagnosis, and it isn’t a treatment target either. In fact, no guideline treats this subtraction as something to specifically treat — treatment targets both numbers themselves, not the difference between them.
Different countries’ guidelines actually weigh this figure differently: the 2023 European hypertension guideline cites it as an arterial stiffness criterion, while the more recent 2025 American guideline doesn’t include it as either a criterion or a treatment target at all. Rather than being confusing, this is genuinely reassuring: if the guidelines themselves don’t agree on how much weight to give this number, no single reading should cause alarm on its own. It’s one more piece of context, not a grade on an exam.
Why the Gap Widens With Age
This is the part that’s rarely explained clearly, and it’s what makes everything else make sense. Your two blood pressure numbers don’t age the same way. Systolic pressure (the top number) tends to rise throughout life. Diastolic pressure (the bottom number) rises only