What It Means When You Only Have High Systolic Blood Pressure

If your blood pressure screening revealed that only your systolic reading (the first number) is higher than normal, but your diastolic reading (the second number) is fine, you may wonder if you'll need treatment. The quick answer to this is yes, though the treatment options vary depending on what's going on.

Variations in Blood Pressure Readings

Having high systolic blood pressure is most likely just a variation of “regular” high blood pressure.

Everyone’s body is a little different, and it's not uncommon for patients to have one number (systolic or diastolic) that's more elevated than the other. Some people have elevated systolic pressure but normal, or even below normal, diastolic pressure. It's also possible to have an elevated diastolic pressure with a normal systolic pressure, though this is less common.

Understanding Systolic Blood Pressure

When your heart is actively beating, systole occurs. That's 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 cardiac contraction is called the systolic blood pressure. Diastolic pressure is the pressure felt on the blood vessels between heartbeats. Blood pressure is recorded as systolic over diastolic, such as 120/80.

Isolated Systolic Hypertension

A condition called isolated systolic hypertension occurs when your systolic pressure rises to 140 mm Hg or above and the diastolic pressure remains below 90 mm Hg.

Isolated systolic hypertension usually affects older people and is the result of a very clear and known disease process somewhere else in the body. Common causes are stiff arteries (a risk for heart disease and stroke), overactive thyroid, or diabetes. Your doctor will treat this condition to keep your diastolic pressure at least 70 mm Hg while bringing down your systolic blood pressure.

Ordinary High Blood Pressure

While there is no universal rule, a good rule of thumb to consider is that the systolic pressure in isolated systolic hypertension is usually very high, often close to 200. If your systolic pressure is elevated and your diastolic pressure is not, that doesn’t mean you have isolated systolic hypertension. Instead, it most likely means you have standard high blood pressure. Your doctor will be able to tell for sure.

The term "high blood pressure" is most often used by physicians when a patient has a systolic blood pressure of 140mm Hg or higher (top number) and/or diastolic pressure (bottom number) of 90mmHg or above.

Because cases where one number is more elevated over baseline than the other number usually represent standard hypertension, the treatment options are the same and include exercise, a low sodium diet, and potentially medications such as beta blockers, ACE inhibitors, ​diuretics, antihypertensives, or calcium channel blockers. In cases of true isolated systolic hypertension, the treatment options are different and usually, several treatments are tried at the same time.

When to See Your Doctor

If you've noticed your blood pressure readings show this “one is elevated, one is not” pattern, tell your doctor.

He or she can run different tests to make sure that there isn't some other, underlying problem that needs to be addressed. Depending on your personal medical history, figuring this out might go quickly, or it may take a bit of time as your doctor builds up a blood pressure record and checks for any underlying disease.