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

The time during a heartbeat is known as systole. This is when 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 120/80.

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, more above normal than the other.


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.


Isolated systolic hypertension causes

Verywell / Nusha Ashjaee

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 isolated systolic hypertension is 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.


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.

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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.

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.
  1. 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

  2. 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 studyJ Am Coll Cardiol. 2015;65(4):327–335. doi:10.1016/j.jacc.2014.10.060

  3. Tan JL, Thakur K. Systolic hypertension. StatPearls Publishing.

  4. 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

  5. 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

  6. 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

By Craig O. Weber, MD
Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years.