In hemorrhage, which statement best describes the relationship between systolic pressure and pulse pressure?

• A. The systolic pressure is often maintained while the pulse pressure narrows.
• B. The systolic pressure increases dramatically, widening pulse pressure.
• C. Both systolic and pulse pressures fall equally.
• D. Pulse pressure increases while systolic stays the same.

Answer: (A)

In hemorrhage, the body’s main goal is to preserve arterial pressure despite losing blood volume, so compensatory mechanisms come into play. The sympathetic response increases heart rate and causes vasoconstriction, which helps keep the systolic pressure relatively stable or only mildly reduced. At the same time, peripheral constriction raises diastolic pressure. Because pulse pressure is the difference between systolic and diastolic pressures, this combination narrows the pulse pressure. So you often see a near-normal systolic pressure with a reduced pulse pressure in early hemorrhage. As bleeding worsens, systolic pressure may fall and the pattern can change, but the early pattern is preservation of systolic pressure with narrowing pulse pressure.