Influence of Gender on the Level of Pulse Pressure: The Role of Large Conduit Arteries

The blood pressure curve may be divided into two components: a steady component represented by the mean arterial pressure, and a pulsatile component represented by the purse pressure. Whether the contribution of either these two components may be different in men and women was not yet investigated. The present study used 24 hours ambulatory brachial blood pressure monitoring and determination of casual carotid and radial pulse pressure by applanation tonometry to investigate 320 subjects (199 men and 121 women) with normal or elevated blood pressure. With ambulatory blood pressure monitoring, there was no gender influence on the mean values of mean and diastolic blood pressure, but men were characterized by a significantly higher systolic and pulse pressure (P < 0.001). In women, pulse pressure was strongly and positively correlated with systolic (and not diastolic) blood pressure. In men, pulse pressure was positively correlated with systolic blood pressure and negatively with diastolic blood pressure (P < 0.001). In the overall population (men plus women), brachial ambulatory pulse pressure was positively correlated with body height and mean arterial pressure (P < 0.001) but the latter correlation was stronger in women. Applanation tonometry indicated that, whereas carotid pulse pressure was identical in men and women, men had a significantly higher radial systolic blood pressure, indicating a gender difference in pressure wave transmission. The study provides evidence that men and women did not differ in terms of mean arterial pressure, but rather in terms of pulse pressure and pressure wave transmission, indicating that large (and not only small) arteries modulate the gender difference in the level of blood pressure. This finding may have important implications for the diagnosis and the clinical management of subjects with hypertension.