PULSE pressure emerged as a strong predictor of disease severity and adverse outcomes in patients with stable coronary artery disease (CAD), according to new prospective research.
Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, and identifying reliable markers of risk in stable CAD is critical. Pulse pressure, defined as the difference between systolic and diastolic blood pressure, reflects arterial stiffness and vascular ageing, both key contributors to cardiovascular risk.
Pulse Pressure Linked to Disease Severity
In a cohort of 7,027 patients with stable CAD and normal ejection fraction, investigators observed that both systolic blood pressure and pulse pressure increased in line with higher Gensini Score quartiles, a measure of coronary lesion severity.
Notably, the proportion of patients with three-vessel disease rose significantly across pulse pressure quartiles (p<0.001), highlighting a clear association between elevated pulse pressure and more extensive coronary involvement.
Pulse Pressure and Cardiovascular Outcomes
Over a median follow-up of 36.4 months, 289 cardiovascular events were recorded. On univariate analysis, pulse pressure and systolic blood pressure were both associated with cardiovascular death, stroke, and combined outcomes (p<0.05).
However, after adjusting for confounding factors, pulse pressure remained independently associated with stroke (hazard ratio: 1.019; 95% CI: 1.005–1.033) and combined outcomes (hazard ratio: 1.014; 95% CI: 1.005–1.023).
In contrast, systolic blood pressure retained significance only for stroke risk.
Patients in the highest pulse pressure quartile consistently demonstrated a greater likelihood of stroke and overall adverse cardiovascular outcomes, reinforcing the prognostic value of this measure.
Clinical Implications of Pulse Pressure
These findings suggested that pulse pressure may serve as a pivotal and easily accessible marker for risk stratification in stable CAD. Unlike more complex imaging or biomarker approaches, pulse pressure can be routinely assessed in clinical practice, offering a practical tool to identify patients at higher risk of adverse events.
The study underscored the importance of pulse pressure as more than a simple haemodynamic measure, positioning it as a potentially valuable predictor of both disease severity and long-term risk in stable CAD.
Further studies are needed to validate pulse pressure in clinical risk models and explore its integration into routine cardiovascular assessment.
Reference
Zhang Y et al. Pulse pressure associates with severity and worse outcomes in patients with stable coronary artery disease. npj Cardiovasc Health. 2026;DOI:10.1038/s44325-026-00118-5.
Featured image: wutzkoh on Adobe Stock
