Dear Dr. SerVaas: Some time ago I read that it is not healthy to have a great difference between the upper (systolic) and lower (diastolic) blood pressure readings. Mine is often 120/ 45 or 129/50. Would you tell me why this is not good?

Phyllis Jaremka
Buffalo, New York

Dear Reader: Dr. Keith L. March, director of the Indiana Center for Vascular Biology and Medicine, responds to your query:

"Indeed it is correct that elevated pulse pressure (the difference between the systolic and diastolic readings) has been associated with an increased likelihood of adverse cardiovascular outcomes. This seems to be a factor that adds to the problems due to elevated blood pressure alone. Higher pulse pressure is a result of a stiffer-than-normal artery accepting the blood flow as it is pumped out by the heart. Basically, high pulse pressure indicates a stiff vessel system, which is not good in itself and also seems to place a particular strain on the heart.

"Having explained this, it is important to point out that I do not think that this may necessarily apply to you. Discussions usually involve pulse pressure in patients with elevated blood pressure. In fact, at least one study did not find an association between elevated pulse pressure and adverse cardiovascular outcomes in people without high pressure per se.

"With the pressures you mentioned, the low-ish diastolic pressure makes me want to be sure that you do not have any leak in your aortic valve. As long as your doctor says that your valves are OK, I would not overly worry about the pulse pressure in your case, since your blood pressure seems as controlled as it can be."