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.

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.

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.

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

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 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.

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.

“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.

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.

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.

Hypertension Healthcare Provider Discussion Guide

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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.

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.

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.

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.

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.

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).

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.