High Systolic Blood Pressure - Isolated Systolic Hypertension

Covering high systolic blood pressure cause, symptoms, guidelines, treatment, readings, in pregnancy and in elderly people.



High systolic blood pressure is also known as systolic hypertension or isolated systolic hypertension (ISH). Systolic hypertension is therefore defined as an elevated systolic blood pressure of a reading of greater than 140mm Hg (>140) with a normal diastolic blood pressure reading of less than or equal to 90mm Hg (<90). This definition is consistent with the 6th report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The WHO/ISH guidelines now also define isolated systolic hypertension at >140/<90mm Hg. This is evidently more stringent than the earlier and older definition of systolic hypertension at >160/<90mm Hg.

Isolated systolic hypertension causes

High systolic blood pressure is the most common type of hypertension in elderly people. It is the most prevalent type of untreated hypertension among persons over 60 years of age. In fact an estimated 70% of its patients are over the age of 60 years. In most cases there can be no specific identifiable cause of systolic hypertension. General hypertension causes are however known but to an extent. The following factors have however been shown to increase the risk of systolic hypertension;

  • Obesity/Overweight
  • Tobacco smoking
  • Diabetes (body sugar level)
  • Age- the elderly are more susceptible (see subsequent paragraph)
  • Heritage background - African American or Caucasian males are at greater risk
  • Pregnancy and delivery before the age of 25 years. This risk may be associated with hormonal fluctuations related to pregnancy which may pre-dispose women in this category to systolic hypertension later in life. This also extends to abnormal menstrual cycles as a precursor to later life systolic hypertension

These factors simply predisposes individuals to high systolic blood pressure but are not in themselves causes of isolated systolic hypertension.

Isolated systolic hypertension in elderly people

elderly systolic hypertension coupleAs earlier stated, systolic blood pressure is the most common form of high blood pressure in those individuals at 60 years old or more. Predictably due to the ever advancing medical procedures and treatment to do with health in general especially in the western world, isolated systolic hypertension is becoming more prevalent as the 65 years plus age group continues to expand so rapidly.

Whereas in many years past doctors considered an elevation of diastolic pressure to be more important that that of systolic pressure; there has been a paradigm shift. Today high systolic blood pressure combined with lowered diastolic pressures also known as widening of the pulse pressure are key ingredients of cardiovascular risk more so in the elderly.

Doctors use the widening pulse pressure to indicate a rise in systolic levels and fall in diastolic levels. This widening pulse pressure further speaks of atherosclerotic stiffening of the aorta and large capacitance vessels (veins capable of holding and storing blood) largely associated with advanced age. Age affects the aorta (the large trunk artery that carries blood from the left ventricle of the heart to branch arteries) putting increased load on the ventricle which jeopardizes blood flow in the coronary.

Put another way, the development of systolic blood pressure with advancing age is as a result of a deterioration of arterial compliance of the large conduit arteries in particular. This involves increasing arterial stiffness as a result of structural and functional changes in the vascular wall. Amazingly, diastolic blood pressure does not increase all through these developments and may even be lowered due to increased arterial stiffness.

Isolated systolic hypertension symptoms



malignant hypertension monitorUnlike symptoms of hypertension found in other types of hypertension such as malignant hypertension and pulmonary hypertension symptoms, high systolic blood pressure largely remain asymptomatic for many years. The use of accurate blood pressure equipment such as the Omron blood pressure monitor range or any other reputable monitor is absolutely important as the presence of systolic hypertension is detected by repeated accurate out-of-office measurements. The end points of high systolic blood pressure are strokes, hear failure and heart attacks amongst many other high mortality complications.

Isolated systolic hypertension symptoms

Treatment of isolated systolic hypertension is absolutely necessary as is provides considerable protection against cardiovascular mortality as well as morbidity. Controlling systolic blood pressure will to an extent prolong life and reduce strokes, heart attacks and occurrences of heart failure. Onset of dementia will also be possibly reduced.

In treating high systolic blood pressure, research involving some 7500 elderly patients has shown that in as much as hypertension medications are used to lower high systolic pressure caution should also be taken not to further lower diastolic blood pressure. This has caused deaths in some patients even after having achieved controlled or lower systolic readings. Low blood pressure in general can be harmful and there are different causes of low blood pressure.

There are evidently three key areas to be seriously considered as attention is directed towards the control of systolic hypertension;

  • Doctors will have to determine at what high systolic blood pressure level should treatment with drugs commence. This is were hypertension guidelines for treatment become extremely handy. Non-drug therapies such as hypertension diet and general changes in lifestyle have been shown to be effective but often not adequate. As a side note, patients on non-drug therapies might eat fruits and vegetables such as celery which is known for helping control high blood pressure. They may also be required to avoid caffeine mostly consumed in coffee which has been shown to cause blood pressure spikes. All having said and done concerning lifestyle modification, a staggering percentage of systolic hypertension patients requires consistent high blood pressure treatment
  • Doctors will have to consider which high blood pressure treatment to use in terms of drugs.
  • A critical consideration is also to what level the blood pressure should be lowered.

High systolic blood pressure treatment after being carefully considered necessary taking into account white coat hypertension will include low-dose diuretics or dihydropyride calcium-channel blockers (CCBs). It is more desirable theoretically to find anti-hypertensive drugs which reduce systolic blood pressure more markedly than diastolic blood pressure. High systolic blood pressure should be treated gently by aiming to lower systolic readings to near 140mm Hg at the same time ensuring that diastolic pressure is not lowered much below 70mm Hg. This indeed sounds like a balancing act approach.

Patients with lesser elevations of systolic blood pressure might do fine with active therapy if at high risk due to other diseases such as concomitant diabetes, renal dysfunction, heart failure and others.




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