Isolated Systolic Hypertension

Isolated systolic hypertension is a type of high blood pressure in which your systolic (top) number is high. With this condition, your top number is in the hypertensive range of 130 millimeters of mercury (mmHg) or higher, but your diastolic (bottom) number may be lower than 80 mmHg. A normal blood pressure reading is lower than 120 mmHg (systolic) and lower than 80 mmHg (diastolic).

Without treatment, isolated systolic hypertension is dangerous. It can damage your organs just like other types of untreated hypertension can. It raises your risk of heart attack, stroke and death from cardiovascular disease. This is why blood pressure checks are so important and lifesaving. Knowing you have high systolic blood pressure can help you and your healthcare provider plan treatment.

Isolated systolic hypertension is the most common type of high blood pressure.

Symptoms of isolated systolic hypertension

Most people with high systolic blood pressure don’t have any symptoms. This is true for most forms of hypertension. But if your systolic number gets dangerously high — 180 or higher — you may have symptoms like:

• Chest pain or discomfort
• Confusion or changes to your thinking
• Dizziness
• Heart palpitations (the sense that your heart is racing, pounding or flip-flopping)
• Peeing less than usual
• Seizures
• Severe headache
• Signs and symptoms of a stroke, like sudden facial droop, slurred speech or sudden weakness in your arms or legs
• Swelling (edema)
• Vision changes, like eye pain, loss of vision or sudden blurred vision

This is called a hypertensive emergency. Call 911 or your local emergency services number if your systolic number is 180 or higher and you have any of these symptoms.

What causes high systolic blood pressure?

Changes to your arteries that occur with aging may cause increases in both your systolic and diastolic blood pressure. As you get older, your arteries become stiff and less elastic. This is often due to the gradual buildup of plaque in your artery walls (atherosclerosis). These changes mean your arteries can’t expand and contract as well as they did before. When this happens, your systolic blood pressure goes up.

Risk factors

You’re more likely to develop isolated systolic hypertension if you:

• Have high cholesterol
• Consume a diet of high-sodium or highly processed foods
• Have diabetes
• Don’t get enough physical activity
• Have a BMI greater than 30
• Use tobacco products

Isolated systolic hypertension has been on the rise in people younger than 40 — particularly, males with an elevated BMI who smoke and don’t get enough physical activity. Despite this, there are sometimes organic causes of high blood pressure in younger individuals, like hormonal imbalances and narrowing of the arteries that supply blood to your kidneys.

Complications of this condition

Without treatment, high systolic blood pressure can lead to serious problems with your heart and blood vessels. Research has linked isolated systolic hypertension with a higher risk of:

• Heart attack
• Stroke
• Chronic kidney disease (CKD)
• Death from any type of cardiovascular disease

You’re also at risk of developing hypertensive heart disease. This is a group of health issues that happen when you have unmanaged high blood pressure for a long time.

How doctors diagnose this condition

A healthcare provider will perform a physical exam and measure your blood pressure. They’ll diagnose you with isolated systolic hypertension if:

• Your systolic blood pressure is 130 or higher at two separate visits (with at least two readings taken each time)

AND:

• Your diastolic blood pressure is lower than 80

Your provider may do some tests to find out your risk of cardiovascular (heart and blood vessel) diseases, including:

• Electrocardiogram (EKG) to check your heart’s rate and rhythm
• Blood tests, like a lipid panel, to check your cholesterol and other important levels

How is isolated systolic hypertension treated?

Treatment involves making changes to your daily habits and possibly taking medicine (antihypertensives) to lower your blood pressure. Changes your provider may recommend include:

• Eating less salt or following the DASH diet
• Eating fresh fruits and veggies
• Reaching and maintaining a weight that’s healthy for you
• Getting more aerobic exercise
• Limiting or avoiding alcohol
• Managing stress
• Quitting smoking or using any tobacco products
• Stopping the use of NSAID medications

Specific medicines used

Isolated systolic hypertension medications include:

• Diuretics
• Calcium channel blockers
• Angiotensin-converting enzyme inhibitors (ACE inhibitors)
• Angiotensin II receptor blockers (ARBs)

Your provider may prescribe one of the first two medicines in the above list. Then, they may add a second or third one, depending on how your body responds.

Be sure to take your medicine exactly as your provider says to. It’s easier to stick to the dosing schedule if you make it a habit. You may want to set a timer or make a note to remind yourself to take your medicine. Never stop taking your medicine without talking to your provider first.

When should I see my healthcare provider?

If your provider prescribes medication for your isolated systolic hypertension, they may want to see you again in a month. This will allow them to see if the medicine is helping you or if it’s causing any side effects.

In the meantime, they may ask you to check your blood pressure at home at least once a week. Reviewing a log of your readings over four weeks or more can help your provider see if the medicine’s working for you.

Your provider will also want to make sure that your diastolic blood pressure doesn’t drop too low, along with your systolic number. A diastolic number that’s too low can mean you’re not getting enough blood flow to your organs. They’ll adjust your medicines as needed to prevent this problem.

What questions should I ask?

It may help to ask your provider:

• How often should I follow up with you?
• How do I start an exercise program?
• Do I need to take medicine, or are habit changes enough for my situation?
• What time of day is best for me to take my medicine?

What can I expect if I have high systolic blood pressure?

You’ll work with your healthcare provider to get your blood pressure to a healthy level — and then to keep it that way. This may involve changing what you eat, moving around more or quitting smoking. It’s important to do these things so you can lower your risk of serious problems later on.

Isolated systolic hypertension is a long-term condition. You’ll need to treat it for the rest of your life. Your provider may change your medicines or their doses over time.

The good news is that treatment can make a big difference in what you can expect down the road. It can lower your risk of heart attack, stroke and death.

As with many health conditions, an early diagnosis gives you the best chance of managing isolated systolic hypertension well.