A 55-year-old hypertensive man has a stroke volume of 60 mL, ejection fraction of 40%, and heart rate of 80 bpm. His pulse pressure is narrowed. Which hemodynamic parameter is most directly responsible for his reduced pulse pressure?
- A Increased arterial compliance causing absorption of the pulse wave
- B Reduced stroke volume per beat leading to less systolic pressure rise ✓
- C Increased peripheral resistance reducing the pressure gradient
- D Reduced heart rate allowing greater diastolic filling and runoff
Correct answer: B. Reduced stroke volume per beat leading to less systolic pressure rise
Explanation
Pulse pressure = Systolic BP – Diastolic BP, and is primarily determined by stroke volume and arterial compliance. This patient's reduced EF (40%) means less volume is ejected per beat, generating less systolic pressure rise. In systolic heart failure, narrowed pulse pressure reflects reduced stroke volume despite possibly normal or elevated diastolic pressure from incomplete relaxation or fluid retention. Increased arterial stiffness typically widens pulse pressure (as in isolated systolic hypertension of aging).
Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.
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