In a blood pressure reading, is having a high top number but an OK bottom number cause for concern?

Answer From Francisco Lopez-Jimenez, M.D.

Yes. If your top blood pressure number is high and your bottom number is within a healthy range, talk with your healthcare professional. You may have a type of high blood pressure called isolated systolic hypertension. But it takes more than one blood pressure test to confirm the condition.

In a blood pressure reading, the top number is called systolic blood pressure. The bottom number is called diastolic blood pressure. Both numbers are measured in millimeters of mercury (mm Hg). In general, a blood pressure reading of 120/80 mm Hg or lower is ideal.

Isolated systolic hypertension happens when the top blood pressure number is 130 mm Hg or higher and the bottom number is less than 80 mm Hg. Isolated systolic hypertension is the most common type of high blood pressure, especially in older age.

Isolated systolic hypertension can be caused by conditions such as:

  • Artery stiffness.
  • An overactive thyroid, also called hyperthyroidism.
  • Diabetes.
  • Heart valve disease.
  • Obesity.

Over time, having a top blood pressure number that is high can raise the risk of stroke, heart disease, dementia and chronic kidney disease.

For adults with high blood pressure, a target blood pressure under 130/80 mm Hg is recommended for those younger than 65. For those 65 and older, American Heart Association guidelines say the top blood pressure number also should be under 130 mm Hg. But the guidelines don't specify a goal for the bottom number. Ask your healthcare team what blood pressure goal is best for you.

Blood pressure medicine can help control isolated systolic hypertension and lower the risk of related health conditions. But it's important that the treatment to lower your top blood pressure number doesn't cause your bottom number to drop too low. That can cause other complications.

If you have isolated systolic hypertension, see your healthcare team for all follow-up appointments. That way, the care team can make sure that your treatment and lifestyle changes are helping control your blood pressure.

Along with medicine, other changes also can help improve the top blood pressure number and boost heart health. Important changes include:

  • Eat a healthy diet. This includes plenty of fruits, vegetables, lean protein and whole grains. Limit food that is high in sugar, sodium and saturated fat.
  • If you drink alcohol, do so in moderation. That means no more than one drink a day for women and two drinks a day for men. Also be aware that it's risky to binge drink even once in a while. Binge drinking means having five drinks for men or four drinks for women in two hours. Binge drinking can raise the risk of an irregular and often very fast heart rhythm called atrial fibrillation.

    If you have high blood pressure, your healthcare professional may recommend not drinking any alcohol at all.

  • Lose extra weight. Reaching and staying at a healthy weight has many benefits. Ask your healthcare professional to set a goal weight that's right for you.
  • Get active. Work up to at least 150 minutes of physical activity a week. Or aim to get at least 75 minutes of vigorous activity a week.
  • If you smoke or vape tobacco, quit. You can ask your healthcare professional for help.
  • Get enough sleep. Adults should aim to get 7 to 9 hours of sleep each night.
  • Manage cholesterol. High levels of LDL cholesterol, the "bad" cholesterol, raise the risk of heart disease. Work with your healthcare professional to make sure your cholesterol stays within a healthy range.
  • Control blood sugar. High blood sugar can harm the heart and other organs over time. If your blood sugar is high, work with your healthcare professional to bring it into a healthy range.

With

Francisco Lopez-Jimenez, M.D.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

April 25, 2024 See more Expert Answers

See also

  1. Medication-free hypertension control
  2. Alcohol: Does it affect blood pressure?
  3. Alpha blockers
  4. Amputation and diabetes
  5. Angiotensin-converting enzyme (ACE) inhibitors
  6. Angiotensin II receptor blockers
  7. Anxiety: A cause of high blood pressure?
  8. Arteriosclerosis / atherosclerosis
  9. Artificial sweeteners: Any effect on blood sugar?
  10. AskMayoMom Pediatric Urology
  11. Beta blockers
  12. Beta blockers: Do they cause weight gain?
  13. Beta blockers: How do they affect exercise?
  14. Birth control pill FAQ
  15. Blood glucose meters
  16. Blood glucose monitors
  17. Blood pressure: Can it be higher in one arm?
  18. Blood pressure chart
  19. Blood pressure cuff: Does size matter?
  20. Blood pressure: Does it have a daily pattern?
  21. Blood pressure: Is it affected by cold weather?
  22. Blood pressure medication: Still necessary if I lose weight?
  23. Blood pressure medications: Can they raise my triglycerides?
  24. Blood pressure readings: Why higher at home?
  25. Blood pressure test
  26. Blood pressure tip: Get more potassium
  27. Blood sugar levels can fluctuate for many reasons
  28. Blood sugar testing: Why, when and how
  29. Bone and joint problems associated with diabetes
  30. How kidneys work
  31. Bump on the head: When is it a serious head injury?
  32. Caffeine and hypertension
  33. Calcium channel blockers
  34. Calcium supplements: Do they interfere with blood pressure drugs?
  35. Can whole-grain foods lower blood pressure?
  36. Central-acting agents
  37. Choosing blood pressure medicines
  38. Chronic daily headaches
  39. Chronic kidney disease
  40. Chronic kidney disease: Is a clinical trial right for me?
  41. Coarctation of the aorta
  42. COVID-19: Who's at higher risk of serious symptoms?
  43. Cushing syndrome
  44. DASH diet
  45. DASH diet: Recommended servings
  46. Sample DASH menus
  47. Diabetes
  48. Diabetes and depression: Coping with the two conditions
  49. Diabetes and exercise: When to monitor your blood sugar
  50. Diabetes and heat
  51. 10 ways to avoid diabetes complications
  52. Diabetes diet: Should I avoid sweet fruits?
  53. Diabetes diet: Create your healthy-eating plan
  54. Diabetes foods: Can I substitute honey for sugar?
  55. Diabetes and liver
  56. Diabetes management: How lifestyle, daily routine affect blood sugar
  57. Diabetes symptoms
  58. Diabetes treatment: Can cinnamon lower blood sugar?
  59. Using insulin
  60. Diuretics
  61. Diuretics: A cause of low potassium?
  62. Diuretics: Cause of gout?
  63. Dizziness
  64. Do infrared saunas have any health benefits?
  65. Drug addiction (substance use disorder)
  66. Eating right for chronic kidney disease
  67. High blood pressure and exercise
  68. Fibromuscular dysplasia
  69. Free blood pressure machines: Are they accurate?
  70. Home blood pressure monitoring
  71. Glomerulonephritis
  72. Glycemic index: A helpful tool for diabetes?
  73. Guillain-Barre syndrome
  74. Headaches and hormones
  75. Headaches: Treatment depends on your diagnosis and symptoms
  76. Heart and Blood Health
  77. Herbal supplements and heart drugs
  78. High blood pressure (hypertension)
  79. High blood pressure and cold remedies: Which are safe?
  80. High blood pressure and sex
  81. High blood pressure dangers
  82. How does IgA nephropathy (Berger's disease) cause kidney damage?
  83. How opioid use disorder occurs
  84. How to tell if a loved one is abusing opioids
  85. What is hypertension? A Mayo Clinic expert explains.
  86. Hypertension FAQs
  87. Hypertensive crisis: What are the symptoms?
  88. Hypothermia
  89. I have IgA nephrology. Will I need a kidney transplant?
  90. IgA nephropathy (Berger disease)
  91. Insulin and weight gain
  92. Intracranial hematoma
  93. What is kidney disease? An expert explains
  94. Kidney disease FAQs
  95. Kratom for opioid withdrawal
  96. L-arginine: Does it lower blood pressure?
  97. Late-night eating: OK if you have diabetes?
  98. Lead poisoning
  99. Living with IgA nephropathy (Berger's disease) and C3G
  100. Low-phosphorus diet: Helpful for kidney disease?
  101. Medications and supplements that can raise your blood pressure
  102. Menopause and high blood pressure: What's the connection?
  103. Molar pregnancy
  104. MRI: Is gadolinium safe for people with kidney problems?
  105. New Test for Preeclampsia
  106. Nighttime headaches: Relief
  107. Nosebleeds
  108. Obstructive sleep apnea
  109. Obstructive Sleep Apnea
  110. Opioid stewardship: What is it?
  111. Pain Management
  112. Pheochromocytoma
  113. Picnic Problems: High Sodium
  114. Pituitary tumors
  115. Polycystic kidney disease
  116. Polypill: Does it treat heart disease?
  117. Poppy seed tea: Beneficial or dangerous?
  118. Porphyria
  119. Postpartum preeclampsia
  120. Preeclampsia
  121. Prescription drug abuse
  122. Primary aldosteronism
  123. Pulse pressure: An indicator of heart health?
  124. Mayo Clinic Minute: Rattlesnakes, scorpions and other desert dangers
  125. Reactive hypoglycemia: What can I do?
  126. Renal diet for vegetarians
  127. Resperate: Can it help reduce blood pressure?
  128. Scorpion sting
  129. Secondary hypertension
  130. Serotonin syndrome
  131. Sleep deprivation: A cause of high blood pressure?
  132. Sleep tips
  133. Snoring
  134. Sodium
  135. Spider bites
  136. Stress and high blood pressure
  137. Symptom Checker
  138. Takayasu's arteritis
  139. Tapering off opioids: When and how
  140. Tetanus
  141. Tetanus shots: Is it risky to receive 'extra' boosters?
  142. The dawn phenomenon: What can you do?
  143. Understanding complement 3 glomerulopathy (C3G)
  144. Understanding IgA nephropathy (Berger's disease)
  145. Vasodilators
  146. Vegetarian diet: Can it help me control my diabetes?
  147. Vesicoureteral reflux
  148. Video: Heart and circulatory system
  149. How to measure blood pressure using a manual monitor
  150. How to measure blood pressure using an automatic monitor
  151. Obstructive sleep apnea: What happens?
  152. What is blood pressure?
  153. Can a lack of vitamin D cause high blood pressure?
  154. What are opioids and why are they dangerous?
  155. White coat hypertension
  156. Wrist blood pressure monitors: Are they accurate?
  157. Xylazine
  158. Effectively managing chronic kidney disease
  159. Mayo Clinic Minute: Do not share pain medication
  160. Mayo Clinic Minute: Avoid opioids for chronic pain
  161. Mayo Clinic Minute: Be careful not to pop pain pills
  162. Mayo Clinic Minute: Out of shape kids and diabetes