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With isolated systolic hypertension, your diastolic (bottom) blood pressure number is normal, but your systolic (top) number is high. This type of high blood pressure is the most common kind that people 70 and older have, but it happens in younger people, too. Treatments can help you manage it.
Isolated systolic hypertension is a condition in which only your systolic (top) number is high when you check your blood pressure. With this condition, your systolic number can be higher than 130 millimeters of mercury (mmHg) while your diastolic (bottom) number is lower than 90 millimeters of mercury.
A normal blood pressure reading is less than 120 mmHg (systolic) and less than 80 mmHg (diastolic). Systolic blood pressure measures the force of your blood pushing against your blood vessel walls as your heart pumps blood out of itself to the rest of your body. Diastolic blood pressure measures your arteries’ resistance to stretch during the time your heart relaxes.
According to estimates, 15% of people 60 and older have isolated systolic hypertension. It’s the most common type of high blood pressure in people age 70 or older.
Yes, isolated systolic hypertension is dangerous when you don’t get treatment for it. Without treatment, it can damage your organs just like other types of untreated hypertension (high blood pressure) can. Isolated systolic hypertension is a risk factor for cardiovascular (heart, cerebral vascular and large blood vessels throughout your body) disease, death and kidney failure.
Isolated systolic hypertension usually isn’t an emergency. However, if your systolic number ever reaches 180 millimeters of mercury suddenly and without warning, you should get immediate treatment. This is a hypertensive crisis.
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As with any type of high blood pressure, you don’t experience symptoms of isolated systolic hypertension early on. Over time, untreated hypertension harms your organs and causes:
With age, your arteries become stiff and less elastic. They can’t expand and contract as well as they did at a younger age. When this happens, your pulse pressure and systolic blood pressure go up. Meanwhile, your diastolic blood pressure goes down because of less elasticity.
Because of the calcium and collagen deposits it puts into arteries, atherosclerosis is another cause of stiff, less flexible arteries. Loss of elasticity in your arteries leads to isolated systolic hypertension.
Risk factors for isolated systolic hypertension include:
Isolated systolic hypertension has been on the rise in people younger than 40. Most young adults who have isolated systolic hypertension:
If you don’t manage isolated systolic hypertension, it can lead to:
A healthcare provider will want to know about your family history, diet, activity level and other medical conditions you have. As with many health conditions, an early diagnosis gives you the best chance of managing isolated systolic hypertension well.
A provider will check your blood pressure at two or three different appointments before diagnosing isolated systolic hypertension. They may want to do other tests to find out your risk of cardiovascular (heart and blood vessel) diseases, such as:
If your healthcare provider diagnoses you with isolated systolic hypertension, you should listen to their recommendations for treating it. Most likely, they’ll tell you to make some changes to your daily routine and possibly order medicine for you.
For treating isolated systolic hypertension, your healthcare provider may recommend you make lifestyle changes, such as:
In addition to lifestyle changes, providers may prescribe antihypertensives for isolated systolic hypertension treatment.
Isolated systolic hypertension medications include:
A 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.
Aging blood vessels and stiff arteries make it more difficult to manage high blood pressure. However, antihypertensive medicines can reduce the stiffness of your arteries somewhat.
Side effects of isolated systolic hypertension treatment include:
Everyone ages, and that leads to some causes of isolated systolic hypertension. However, there are things you can do to lower your risk of the condition, such as:
You’ll get the most benefit if you start isolated systolic hypertension treatment as soon as you have a diagnosis. High blood pressure of any kind puts you at risk for other health issues, such as heart attack and stroke.
Isolated systolic hypertension is a chronic (long-term) condition. You’ll need to treat it for the rest of your life.
No, but you can manage it with lifestyle changes and/or medication.
Researchers have found that treating isolated systolic hypertension made a big difference. It decreased people’s risk of heart-related events, stroke and death by as much as 30%.
To manage isolated systolic hypertension, you’ll need to keep taking the medicine your healthcare provider prescribed for you. It’s easier to stick to the dosing schedule if you make it a habit. You can set a timer or make a note to remind yourself to take your medicine. Exercising and eating foods low in fat and salt can help with your blood pressure and heart health, too.
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 troublesome side effects.
In the meantime, they may ask you to check your blood pressure at home once a week or more often. If you show them those readings from the past four weeks, your provider can 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.
You should seek emergency medical care when you’re having a hypertensive crisis. This is a blood pressure of 180/120 millimeters of mercury or higher.
Symptoms include:
Questions to ask your healthcare provider may include:
A note from Cleveland Clinic
If you have isolated systolic hypertension, you’re not alone. Many people have this form of high blood pressure. There are many lifestyle changes you can make that can help you. You have the power to make those changes. If needed, medicines are available. Managing this condition is an investment in your future health and your future self will thank you for it.
Last reviewed by a Cleveland Clinic medical professional on 01/31/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy