What Does It Mean If You Only Have High Systolic Blood Pressure?

Is It Ordinary Hypertension or Isolated Systolic Hypertension?

Human heart, artwork
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After getting their blood pressure measured, many people wonder if they will need treatment if only their systolic blood pressure reading is considered higher than normal. The quick answer to this is yes, though the treatment options vary.

Having high systolic blood pressure is most likely just a variation of “regular” high blood pressure. Everyone’s body is a little different, and it is not uncommon for patients to have one number (systolic or diastolic) that is more elevated than the other.

Some people have elevated systolic pressure but normal, or even below normal diastolic pressure. It is also possible to have an elevated diastolic pressure with a normal systolic pressure, though this is less common.

What is Systolic Blood Pressure?

When the heart is actively beating, “systole” occurs. That's when blood flows from the heart and into the arteries. When blood is being actively pushed into the arteries during systole, the pressure in the arteries increases. The peak blood pressure during cardiac contraction is called the systolic blood pressure. Diastolic pressure is the lower number of the blood pressure reading. It's the pressure felt on the blood vessels between heartbeats. Blood pressure is recorded as systolic over diastolic, such as 120/80.

Isolated Systolic Hypertension

A condition called isolated systolic hypertension occurs when the systolic pressure rises to 140 mm Hg or above and the diastolic pressure remains below 90 mm Hg.

Isolated systolic hypertension usually affects older people and is the result of a very clear and known disease process somewhere else in the body. Common causes are stiff arteries (a risk for heart disease and stroke), overactive thyroid, or diabetes. Your doctor will treat this condition to keep your diastolic pressure at least 70 mm Hg while bringing down your systolic blood pressure.

Ordinary High Blood Pressure

While there is no universal rule, a good rule of thumb to consider is that the systolic pressure in isolated systolic hypertension is usually very high, often close to 200. If your systolic pressure is elevated and your diastolic pressure is not, that doesn’t mean you have isolated systolic hypertension. Instead, it most likely means you have “ordinary” high blood pressure. Your doctor will be able to tell for sure.

The term high blood pressure is most often used by physicians when a patient has systolic blood pressure of 140mm Hg or higher (top number) and/or diastolic pressure (bottom number) of 90mmHg or above.

Because cases where one number is more elevated over baseline than the other number usually represent standard hypertension, the treatment options are the same. In cases of true isolated systolic hypertension, the treatment options are different and usually, several treatments are tried at the same time.

When to See Your Doctor

If you’ve noticed your blood pressure readings show this “one is elevated, one is not” pattern, tell your doctor. He can run different tests to make sure that there is not some other, underlying problem that needs to be addressed.

Depending on your personal medical history, figuring this out might go quickly. Or it may take a bit of time as your doctor builds up a blood pressure record and checks for any underlying disease.


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