Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic), cause for concern?
Answer From Sheldon G. Sheps, M.D.
Yes. If your systolic blood pressure rises, but your diastolic blood pressure stays normal, you have a condition called isolated systolic hypertension.
Isolated systolic hypertension happens when your diastolic blood pressure is less than 80 millimeters of mercury (mm Hg) and your systolic blood pressure is 130 mm Hg or higher. Isolated systolic hypertension is the most common form of high blood pressure in people older than age 65. Younger people can have this type of high blood pressure too.
Isolated systolic hypertension can be caused by underlying conditions such as:
- Artery stiffness
- An overactive thyroid (hyperthyroidism)
- Diabetes
- Heart valve problems
- Obesity
Having a high systolic blood pressure for a long period of time can increase your risk of strokes, heart disease and chronic kidney disease.
The recommended goal for systolic pressure for adults younger than age 65 with a 10% 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.
You'll need medications to control isolated systolic hypertension in order to prevent health problems. But, it's important that your systolic blood pressure treatment doesn't cause your diastolic blood pressure to drop too low. If that happens, you can develop other complications.
In addition to medication, lifestyle changes can also help improve your systolic blood pressure reading. Important changes include:
- Eating a healthy diet
- Decreasing the amount of salt in your diet
- Losing weight if you're overweight or obese
- Increasing physical activity to at least 150 minutes a week of moderate physical activity
- Limiting alcohol to no more than one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and under
Your doctor will ask you to come back for a follow-up appointment to make sure your treatment and lifestyle changes are improving your blood pressure.
Show References
- Basile J, et al. Overview of hypertension in adults. https://www.uptodate.com/contents/search. Accessed March 15, 2020.
- Bavishi C, et al. Isolated systolic hypertension: An update after SPRINT. The American Journal of Medicine. 2016; doi:10.1016/j.amjmed.2016.08.032.
- Bakris GL, et al. Isolated systolic hypertension. In: Hypertension: A Companion to Braunwald's Heart Disease. 3rd ed. Elsevier Saunders; 2018. https://www.clinicalkey.com. Accessed March 18, 2020.
- Egan BM. Treatment of hypertension in older adults, particularly isolated systolic hypertension. https://www.uptodate.com/contents/search. Accessed March 15, 2020.
- McEniery CM, et al. Isolated systolic hypertension in young people is not spurious and should be treated. Hypertension. 2016; doi:10.1161/HYPERTENSIONAHA.116.06547.
- 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. 2018; doi:10.1161/HYP.0000000000000065/-/DC1.
Original article: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/hypertension/FAQ-20058527