Heart Health High Blood Pressure Treatment Understanding Isolated Systolic Hypertension By Craig O. Weber, MD Craig O. Weber, MD Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years. Learn about our editorial process Updated on April 04, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Yasmine S. Ali, MD, MSCI Medically reviewed by Yasmine S. Ali, MD, MSCI Facebook LinkedIn Twitter Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of medicine at Vanderbilt University School of Medicine and an award-winning physician writer. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Measuring Hypertension Symptoms Causes Diagnosis Treatment When to See a Healthcare Provider Frequently Asked Questions If your blood pressure reading reveals that only your systolic reading (the first number) is high but your diastolic reading (the second number) is normal, you may rightly wonder if you'll need high blood pressure treatment. The short and simple answer is yes, although the treatment options will vary based on the underlying cause. When the disparity is extreme enough, it may no longer be referred to as "regular" high blood pressure (hypertension) but a more serious form known as isolated systolic hypertension. Measuring Hypertension When your heart is actively beating, a mechanism known as systole occurs. This is when blood flows from the heart and into your arteries. When your blood is being actively pushed into your arteries during systole, the pressure in the arteries increases. The peak blood pressure during a heart contraction is called systolic. The pressure exerted on the blood vessels between heartbeats is called diastolic. Blood pressure is recorded as systolic over diastolic, such as 120/70 (the upper normal value for most adults). Having high systolic blood pressure is most likely just a variation of "regular" hypertension. Everyone’s body is a little different, and it is not uncommon for people to have one of the two values, either systolic or diastolic, higher than the other. Why Systolic and Diastolic Blood Pressure Are Both Important Symptoms Isolated systolic hypertension is a more serious condition in which your systolic pressure rises well above 140 mmHg (millimeters of mercury), while the diastolic pressure remains below 90 mmHg. While the symptoms are more or less the same as "regular hypertension," there tends to be a greater severity and frequency of them, including headaches, unsteadiness, blurring of vision, arrhythmia (irregular heartbeats), and palpitations. As worrisome as the condition can be, it is the underlying causes that concern healthcare providers as much, if not more. Causes Illustration by Nusha Ashjaee, Verywell Isolated systolic hypertension tends to affect older people and is typically related to a known disease somewhere else in the body. Common causes include: Arteriosclerosis (stiffening of the arteries)Hyperthyroidism (overactive thyroid)Kidney diseaseDiabetesHeart valve problems While primarily seen in adults over 65, younger people can be affected as well. Having a persistently high systolic value is troubling as it can increase your risk of heart attack or stroke. Diagnosis If your systolic pressure is elevated and your diastolic pressure is not, that doesn’t mean you have isolated systolic hypertension. It most likely means you have standard high blood pressure. While the definition can vary by a person's age, weight, and health, isolated systolic hypertension is usually diagnosed when the systolic value is extremely high, often close to 200 mmHg. "Regular" high blood pressure is typically diagnosed when used an adult has a systolic blood pressure of 130mmHg or higher and/or a diastolic pressure of 80mmHg or above. Your healthcare provider will be able to tell the difference. Hypertension Healthcare Provider Discussion Guide Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Treatment The aim of therapy is to keep your diastolic pressure at least 70 mmHg while bringing down your systolic blood pressure to below 120 mmHg. The level of systolic elevation doesn't necessarily alter the basic approach to treatment, including exercise, low-sodium diet, and medications such as beta blockers, ACE inhibitors, diuretics, antihypertensives, or calcium channel blockers. In cases of true isolated systolic hypertension, the treatment would vary only by the combination of antihypertensive drugs used in tandem with the treatment of the underlying cause. When to See a Healthcare Provider If you've noticed your blood pressure readings show irregular elevation patterns, tell your healthcare provider. If the pattern is continuous, the practitioner can run different tests to make sure that there isn't some other, underlying problem that needs to be addressed. Early diagnosis and treatment can help reduce the impact of high blood pressure on your cardiovascular system as well as your risk of heart disease. Frequently Asked Questions How common is isolated systolic hypertension? Isolated systolic hypertension (ISH) is the most common form of high blood pressure in adults over 65. Studies suggest that no less than 15% of adults over 60 have ISH. In some cases, ISH can lead to cerebrovascular disease. What is the average age of onset for systolic hypertension? The average age of onset for isolated systolic hypertension (ISH) is 58.6 years. This is roughly five years later than "regular" hypertension and eight years later than isolated diastolic hypertension (IDH). What is the best medicine for lowering blood pressure? Generally speaking, ACE inhibitors and angiotensin II receptor blockers (ARBs) are considered the preferred options for treating high blood pressure. But, they don't work as well in older adults, who may benefit more from calcium channel blockers and diuretics. Determining if You Have Hypertension Was this page helpful? Thanks for your feedback! Looking to start a diet to better manage your high blood pressure? Our nutrition guide can help. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bavishi C, Goel S, Messerli FH. Isolated systolic hypertension: An update after SPRINT. Am J Med. 2016;129(12):1251-1258. doi:10.1016/j.amjmed.2016.08.032 Yano Y, Stamler J, Garside DB, et al. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. J Am Coll Cardiol. 2015;65(4):327–335. doi:10.1016/j.jacc.2014.10.060 Tan JL, Thakur K. Systolic Hypertension. StatPearls Publishing. Ovbiagele B, Diener HC, Yusuf S, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA. 2011;306(19):2137-44. doi:10.1001/jama.2011.1650 Franklin SS, Pio JR, Wong ND, et al. Predictors of new-onset diastolic and systolic hypertension: the Framington Heart Study. Circulation. 2005;111(9):1121-7. doi:10.1161/01.CIR.0000157159.39889.EC Kaiser EA, Lotze U, Schafer LH. Increasing complexity: which drug class to choose for treatment of hypertension in the elderly? Clin Interv Aging. 2014;9:459–75. doi:10.2147/CIA.S40154 Additional Reading Mayo Clinic. Isolated Systolic Hypertension: A Health Concern?