Is having a high top number (systolic) blood pressure, but an OK bottom number (diastolic) cause for concern?
Answer From Sheldon G. Sheps, M.D.
Yes. If systolic blood pressure rises but diastolic blood pressure stays within an acceptable range, the condition is called isolated systolic hypertension.
Isolated systolic hypertension happens when the diastolic blood pressure is less than 80 millimeters of mercury (mm Hg) and the 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 conditions such as:
- Artery stiffness
- An overactive thyroid (hyperthyroidism)
- Heart valve disease
Having a high systolic blood pressure over time can increase the risk of strokes, heart disease and chronic kidney disease.
The recommended goal for systolic pressure for adults younger than age 65 who have 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.
Controlling isolated systolic hypertension to prevent health problems requires medication. But it's important that the treatment to lower systolic blood pressure doesn't cause the diastolic blood pressure to drop too low. That can cause other complications.
In addition to medication, lifestyle changes can help improve the systolic blood pressure reading. Important changes include:
- Eating a healthy diet.
- Decreasing the amount of salt in the diet.
- Losing weight when indicated.
- Increasing physical activity to at least 150 minutes a week of moderate physical activity.
- Drinking alcohol in moderation, if you choose to drink. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
Your health care provider will ask you to come back for a follow-up appointment to make sure your treatment and lifestyle changes are improving your blood pressure.
June 09, 2022
- Basile J, et al. Overview of hypertension in adults. https://www.uptodate.com/contents/search. Accessed March 15, 2020.
- Rethinking drinking: How much is too much? National Institute on Alcohol Abuse and Alcoholism. https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-toomuch/Whats-the-harm/What-Are-The-Risks.aspx. Accessed Jan. 19, 2022.
- 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.
- 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov/. Accessed Jan. 19, 2022.
- 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.