Wide Pulse Pressure in an Elderly Patient with Diabetes: A Case Report and Literature Review

Abstract

Widened pulse pressure (PP) is a marker of reduced large-artery compliance, most often attributed to age- and diabetes-related arteriosclerosis, but its differential includes aortic regurgitation, hyperthyroidism, arteriovenous fistula, and severe anemia. Antihypertensive drug classes may differentially affect PP, with renin-angiotensin-aldosterone system (RAAS) inhibitors and calcium channel blockers showing greater benefit on its reduction. A 67-year-old woman with hypertension and insulin-dependent diabetes presented with polyuria, dizziness, wide PP (70 mmHg), tachycardia, hyperglycemia, and peripheral edema after prolonged discontinuation of losartan and insulin due to public pharmacy shortages. Aortic regurgitation was excluded by absence of a diastolic murmur and by echocardiography, which showed aortic arch atheromatosis and mild valve calcification without regurgitation. Substitution of carvedilol with olmesartan, alongside correction of hyperglycemia-driven dehydration, was associated with progressive narrowing of PP. This case highlights the clinical rationale for favoring RAAS inhibition over beta-blockade, while emphasizing that medication affordability and supply continuity are as clinically fundamental as pharmacologic choice in resource-limited settings.