Isolated systolic high blood pressure

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Isolated systolic high blood pressure

In isolated systolic high blood pressure (isolated systolic hypertension, or ISH), systolic blood pressure is elevated (above 140 mm Hg), but diastolic blood pressure stays below 90 mm Hg. This type of high blood pressure is more common in older adults, especially older women. In fact, the majority of people older than 60 who have hypertension have isolated systolic hypertension.¹

If you are older than 50, a systolic blood pressure over 140 mm Hg is a more important risk factor for stroke and heart disease than your diastolic blood pressure.²

ISH can cause damage to organs such as the kidneys, brain, heart, or eyes and should be treated. A major study (SHEP) determined that treatment of ISH resulted in a 27% decrease in heart disease and a 36% decrease in stroke.^{1 3}

An observational study has shown that those with diabetes who have a lower systolic blood pressure also have a lower risk of diabetic complications, such as stroke and heart disease.⁴

Treatment of ISH often begins with the use of a diuretic, which seems to be effective in older people. Other medicines that may be used include long-acting calcium channel blockers, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors.

The Dietary Approaches to Stop Hypertension (DASH) diet is effective for treating isolated systolic hypertension.⁵

References

Citations

1. SHEP Cooperative Research Group (1991). Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA, 265(24): 3255–3264.

2. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.

3. Perry H Jr, et al. (2000). Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke. JAMA, 284(4): 465–471.

4. Adler A, et al. (2000) Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. BMJ, 321(7258): 412–419.

5. Moore T, et al. (2001). DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage 1 isolated systolic hypertension. Hypertension, 38(2): 155–158.

Credits

Last updated:	April 24, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Ruth Schneider, MPH, RD - Diet and Nutrition
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC