High Systolic Blood Pressure ...

Even a caveman can have it if he lives long enough. High systolic blood pressure is epidemic in the elderly, 2/3 have it and more women than men. This results from a number of causes discussed below along with the significance and the treatment.

Years ago it was thought that a mild elevation of systolic pressure was OK as long as the diastolic was not elevated. This has been shown to be not true. Either number elevated results in the same amount of complications as if both numbers were elevated.

What Causes High Systolic Blood Pressure?

  • Any condition that raises cardiac output without changing other parameters. Hyperthyroidism, early primary hypertension.
  • A condition where total peripheral resistance is lowered such as arteriovenous fistula.
  • Stiffening of the major arterial blood vessels. By not giving way and expanding when the heart beats, this causes the pressure to spike. This is the mechanism in the vast majority of older people.

Significant Points For High Systolic Blood Pressure:

  • Elevated systolic blood pressure is called “isolated systolic hypertension” or ISH.
  • Diastolic blood pressure rises with age until about age 55, then it declines. Systolic pressure rises steadily with age, without stopping.
  • ”Systolic hypertension is a major health threat, especially for older Americans,” says the National Heart, Lung and Blood Institute.
  • The systolic component is the key determinant for assessing the presence and severity of high blood pressure for middle-aged and older adults.
  • In hypertensives over age 70 only 25% of African Americans and 18% of white Americans are controlled (under 140/90).
  • Treatment should be started as soon as possible to prevent organ damage.

Treatment for High Systolic Blood Pressure: (ISH)

  • Non-pharmaceutical: This is well covered by my page LowerBlood Pressure
  • Pharmaceutical: Low-dose diuretics seem to work well as do dihydropyridine calcium-channel blockers. When both high diastolic and high systolic blood pressure co-exist then ACE (angiotensin converting enzyme) inhibitors are as good if not the better choice.

Doctor’s Practical Guide:

Older Americans with ISH are the least well controlled group of all. This should not be. More attention must be paid to this condition that results in heart attacks, strokes, kidney and heart failure. Learn how to take blood pressure both for yourself and your family. See my page on How and Why at HowTo Take Blood Pressure It is not difficult at all.

Some words of caution: Lowering systolic blood pressure also lowers diastolic. Studies show that lowering diastolic below 77 mm hg increased adverse events.

Also, the tendency for blood pressure to read higher in the office or just when it is read by someone else (“white-coat” phenomenon) becomes more significant in light of the adverse events associated with lowering diastolic too much. This could happen when treatment is given unnecessarily in response to a falsely elevated reading.

But this is a job for you and your doctor who should be able to address your concerns. The worst thing is to just ignore it.

P.S. Be sure to read about my booklet of detailed instruction on taking blood pressure: HowTo Take Blood Pressure Booklet


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