APTA Annual Conference Abstracts

APTA NEXT 2020 Conference, June 3 - 6, 2020

Elevated Resting Pulse Pressure and Blood Pressure in Patients Receiving Outpatient Physical Therapy


Elevated Resting Pulse Pressure and Blood Pressure in Patients Receiving Outpatient Physical Therapy

Jill Danielle Jumper, PT, DPT1, Dennis G. O'Connell, PT, DPT, PhD2, Brad Scott HIcks3, Dwain Ray Klosterman3, Christopher Carl3 and Carmen Bell3, (1)Hardin-Simmons University Department of Physical Therapy, Abilene, TX, (2)Hardin Simmons Univ, Abilene, TX, (3)Abilene, TX


To examine pulse pressures (PP) and blood pressures (Systolic-SBP and diastolic-DBP) in 98 patients arriving for outpatient physical therapy and determine if the distribution differed across risk classes. To determine if right (R) and left (L) arm PP differed from normal. To determine if medication affected SBP, DBP, or PP within the sample.


For adults > 60 yrs, a PP > 60 mmHg is a stronger predictor of cardiovascular morbidity than SBP alone. PP is a useful predictor of myocardial infarction and/or may be suggestive of carotid artery stiffness, valvular regurgitation, anemia, or hyperthyroidism. Physical Therapists should regularly measure PP and cautiously treat patients with elevated SBP, DPB, or PP.


Forty male and 58 female subjects, 65.98 ± 4.19 in, 180.91 ± 39.62 lbs., with a BMI of 29.11 ± 5.86 and a mean age of 64.34 ± 15.92 yrs participated.

Methods and Materials:

Ss sat resting (10-min) and SBP/DBP was measured bilaterally and classified (ACC/AHA 2017 Guidelines) as normal (<120/<80mmHg); elevated (120-129/<80mmHg); Stage 1 (130-139 or DBP 80-89mmHg); Stage 2 (≥140/≥90mmHg), or Hypertensive crisis (>180/>120mmHg). The normal pulse pressure (SBP-DBP) cut-point was set at (< 60mmHg).


A Chi-Square tested for differences across the 5 BP classes. One-sample t-tests were calculated for R and L PP (population value=60mmHg). A 1-way ANOVA tested the effects of medication (none vs. taking Rx) on R and L SBP, DBP, and PP. Statistical significance was set at p <0.05.


Mean R and L BPs were: 132.93 ± 15.81mmHg/76.32 ±-8.85mmHg and 132.23 ±15.69/76.36 ±10.17 mmHg, respectively. Only 18.56% and 20.62% R and L arm SBP values and 54.64% and 61.86% of R and L DBP values, respectively were normal. R and L SBP were classified as elevated (25.8; 22.4%), stage 1 (20.6; 22.4%), stage 2 (34.0, 30.6%) and crisis (1, 1%), respectively. R and L DBP were classified as elevated (11.2%; 15.3%), stage 1 (23.5; 25.5%), and stage 2 (9.2%; 9.5%), respectively. While most Ss had normal DBP, 26.3% of L and 23.5% of R measures were classified as Stage 1 HTN and Stage 2 HTN, respectively. Chi-Square tests found a significant deviation (p<0.05) from hypothesized values for R and L SBP (X2(4)=28.72; X2 (4)=24.42) and R and L DBP (X2(4)=53.39; (X2=(4)=33.30), respectively. Mean R and L PPs were: 56.61 ± 14.47 mmHg and 55.87±1 15.26mmHg, respectively. Normal PP was noted in 60.8% and 61.1% of R and L arms, respectively. One-sample t-tests for R (t(96-=2.308. p=.02) and L (t(94)=-2.635 p=.01) PP were statistically different than 60 mmHg. No significant effect (Lambda(4,86) = .186, p>.05) was found via the 0ne-way MANOVA testing the effect of medication on BP classes or PP. Fifty-six percent of Ss reported taking medications for HTN but approximately 80%, 42%, and 38.5% of Ss had high systolic, diastolic and PP, respectively.


A very high percentage of physical therapy outpatients had elevated PP (38.2%) and BP (79%) regardless of medication. This information should give physical therapists even more incentive to regularly check PP and BP in the outpatient setting and communicate with PCPs to enhance blood pressure control.

REFERENCES (at least five within ten years):
  • Abbott TE, Pearse RM, Archbold RA, Wragg A, Kam E, Ahmad T, Khan AW, Niebrzegowska E, Rodseth RN, Devereaux PJ, Ackland GL. Association between preoperative pulse pressure and perioperative myocardial injury: an international observational cohort study of patients undergoing non-cardiac surgery. Br J Anaesth. 2017 Jul 1;119(1):78-86. doi: 10.1093/bja/aex165.
  • Melo X, Santos DA, Ornelas R, Fernhall B, Santa-Clara H, Sardinha LB. Pulse pressure tracking from adolescence to young adulthood: contributions to vascular health. Blood Press. 2018 Feb;27(1):19-24. doi: 10.1080/08037051.2017.1360724. Epub 2017 Jul 28.
  • Avolio AP, Kuznetsova T, Heyndrickx GR, Kerkhof PLM, Li JK. Arterial Flow, Pulse Pressure and Pulse Wave Velocity in Men and Women at Various Ages. Adv Exp Med Biol. 2018;1065:153-168. doi: 10.1007/978-3-319-77932-4_10.
  • Rahimi K, Mohseni H, Otto CM, Conrad N, Tran J, Nazarzadeh M, Woodward M, Dwyer T, MacMahon S. Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults. PLoS Med. 2017 Oct 17;14(10):e1002404. doi: 10.1371/journal.pmed.1002404. eCollection 2017 Oct.
  • Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Pulse Pressure Predicts Mortality in Elderly Patients. J Gen Intern Med. 2009 Aug; 24(8): 893–896.

*First author