Understanding Isolated Systolic Hypertension

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.

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 doctors as much, if not more.

Causes

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 disease
Diabetes
Heart 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 doctor will be able to tell the difference.

Hypertension Doctor Discussion Guide

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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 Doctor

If you've noticed your blood pressure readings show irregular elevation patterns, tell your doctor. If the pattern is continuous, the doctor 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.