Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic) cause for concern?
Answers from Sheldon G. Sheps, M.D.
Yes. If you have a diastolic number — the bottom number of a blood pressure measurement — less than 80 millimeters of mercury (mm Hg) and a systolic number — the top number of a blood pressure measurement — greater than or equal to 130 mm Hg, you have a common type of high blood pressure called isolated systolic hypertension.
Isolated systolic hypertension can be caused by underlying conditions such as artery stiffness, an overactive thyroid (hyperthyroidism) or diabetes. Occasionally, it can be caused by heart valve problems. It is the most common form of high blood pressure in people older than age 65, but it is possible for younger people to be affected by this type of high blood pressure as well.
Doctors now know that high systolic pressure is as important as high diastolic pressure — and even more important in people older than age 50. Having a high systolic pressure for a long period of time can increase your risk of having significant cardiovascular problems, such as a heart attack or stroke.
The recommended goal for systolic pressure for adults younger than age 65 with a 10 percent or higher risk of developing cardiovascular disease is less than 130 mm Hg. For healthy adults who are age 65 or older, the recommended treatment goal for systolic pressure is also less than 130 mm Hg.
Isolated systolic hypertension can lead to serious health problems, such as:
- Heart disease
- Chronic kidney disease
Your high blood pressure will need to be controlled with medications in order to prevent health problems. However, if your treatment lowers your diastolic pressure too much, you could be more likely to have a heart attack or stroke. So if you have isolated systolic hypertension, your doctor may recommend that your diastolic pressure not be reduced to less than 60 mm Hg in trying to reach your target systolic pressure.
Your doctor might also recommend certain lifestyle changes that could help improve your systolic pressure reading, in addition to your treatment with medication. Eating a healthy diet and decreasing the amount of salt in your diet, losing weight if you're overweight or obese, increasing your physical activity, and limiting how much alcohol you drink can all help manage your blood pressure. Your doctor will need to monitor your treatment and lifestyle changes closely to ensure that you receive the maximum benefit.
April 10, 2018
- Egan BM. Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension. http://www.uptodate.com/home. Accessed Feb. 6, 2017.
- Bavishi C, et al. Isolated systolic hypertension: An update after SPRINT. The American Journal of Medicine. 2016;129:1251.
- Mancia G, et al. Diagnostic and therapeutic problems of isolated systolic hypertension. Journal of Hypertension. 2015;33:33.
- Kaplan NM, et al. Overview of hypertension in adults. http://www.uptodate.com/home. Accessed Feb. 9, 2017.
- Butt DA, et al. Benefits and risks of antihypertensive medications in the elderly. Journal of Internal Medicine. 2015;278:599.
- James PA, et al. 2014 evidence-based blood pressure guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507.
- Duprez D. Treatment of isolated systolic hypertension in the elderly. Expert Review of Cardiovascular Therapy. 2012;10:1367.
- Basile J, et al. Overview of hypertension in adults. https://www.uptodate.com/contents/search. Accessed March 29, 2018.
- Whelton PK, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. In press. Accessed March 29, 2018.
- Egan BM. Treatment of hypertension in older adults, particularly isolated systolic hypertension. https://www.uptodate.com/contents/search. Accessed March 29, 2018.