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What Is Isolated Systolic Hypertension

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Isolated systolic hypertension – Most common hypertension among elderly

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When To See A Doctor

The symptoms of high blood pressure are typically silent. Many people may not find out they have high blood pressure until they visit their doctor for a routine physical. If you dont already have a primary care doctor, the Healthline FindCare tool can help you find a physician in your area.

You can also use a home blood pressure monitor to measure your blood pressure at home. You may want to consider monitoring your blood pressure if you:

  • have overweight or obesity

How Is It Treated

If your systolic blood pressure is too high, your doctor may prescribe medicine to help bring it down. Drugs used to control blood pressure include:

  • Diuretics to help your kidneys flush water and sodium from your body
  • Beta-blockers to make your heart beat slower and less forcefully
  • Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers , or calcium channel blockers to relax your blood vessels
  • Renin inhibitors to keep your kidneys from making a chemical that can lead to higher blood pressure

Your doctor also may recommend you do a few other things:

  • If you smoke, stop. There are lots of good reasons for this, but nicotine in cigarette smoke can raise your blood pressure.
  • Lower the amount of salt in your diet.
  • Cut back on alcohol if you drink.
  • Get to or stay at a healthy weight.

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Enhancing Healthcare Team Outcomes

Systolic hypertension is commonly encountered in clinical practice. Because it is a major risk factor for adverse cardiac events, the condition must be appropriately managed. The nurse practitioner, primary care provider, internist, cardiologist, and emergency room provider must be aware of the latest ACC guidelines on the management of hypertension. Because of the numerous drugs available to treat hypertension, a consult with a cardiologist is highly recommended if there is any doubt about the efficacy of the drug. There is ample evidence showing that when systolic hypertension is well treated, the patients have good outcomes with an interprofessional approach to care.

What Problems Can It Cause

What is the mechanism of Isolated systolic hypertension (ISH) ?

All types of high blood pressure, including isolated systolic hypertension, can slowly damage the inside of your arteries and cause tiny tears in their walls. A chemical called LDL cholesterol can build up in those damaged blood vessels and form a layer called plaque. That makes your arteries narrower and raises your blood pressure even higher.

When that happens, the arteries that carry oxygen to your heart can get blocked, and that can lead to a heart attack or a stroke . It also can make blood vessels in your brain burst, and that can cause a stroke, too.

In other parts of your body, it can strain the blood vessels in your eyes and make you lose your eyesight or damage the arteries around your kidneys so they donât filter your blood the way they should.

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What Can You Do To Prevent High Blood Pressure

You can help lower your risk of high blood pressure by practicing the lifestyle changes mentioned above.

Additionally, consider working with your doctor to carefully manage any preexisting health conditions that can contribute to high blood pressure, such as diabetes or hyperthyroidism.

You can also monitor your blood pressure at home if youd like to keep a closer eye on changes in your blood pressure outside of your routine checkups.

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How Is Isolated Systolic Hypertension Diagnosed

Isolated systolic hypertension is typically asymptomatic to start with. However, it can cause damage to organs that create symptoms as it progresses. Usually, like other forms of high blood pressure, doctors diagnose ISH through routine screening using a blood pressure monitor. It’s vital to have your blood pressure checked regularly, especially as you get older

Untreated isolated systolic hypertension can lead to symptoms including:

Your doctor will not diagnose you with ISH based on a single high reading. Typically, they will take multiple readings to establish whether your systolic pressure is consistently high. Your doctor may use home monitoring to track how your blood pressure changes throughout the day and to ensure its not spiking because of anxiety.

Who Gets Isolated Systolic Hypertension

Isolated systolic hypertension

Older people are more likely to have it, because systolic blood pressure usually goes up as you age.

  • More than 30% of women over 65 and more than 20% of men have this condition.
  • If your parents had high blood pressure, you may be more likely to have it.
  • African-Americans are more likely than other groups to have high blood pressure.

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Can Isolated Systolic Hypertension Be Cured

There is no cure for ISH, but you can manage it with lifestyle changes and medication. Typically, if your doctor puts you on medication for any form of high blood pressure, you will stay on it for life. In some cases, lifestyle changes can bring your blood pressure down to the point where medication is no longer required, or your doctor can decrease your dosage.

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Haemodynamic Findings And Cv Risk

To review the potential CV risk associated with ISHY, the haemodynamic findings were analysed and summarised in Table . Briefly, increased PWV and both normal and increased PP amplification, are noted in ISHY , however, ISHY is rarely associated with an increased heart rate . Increase velocity may occur secondary to increased CO which has been noted in ISHY, and increased distance which is also seen in the taller stature of ISHY individuals . PP demonstrated negative CV effects in the elderly, but not in younger populations . Indeed, increased PP amplitude, a common finding in ISHY, may have positive as opposed to negative CV implications, as seen in the elderly .

Increased CO, a feature of ISHY, has also been noted in overweight and obese individuals , regardless of their SBP . SBP in these individuals does, however, correlate with increased PVR , unlike ISHY in healthy body weight ranges . This suggests that increased CO and SBP in ISHY who are overweight may have a different causative mechanism .

Complications Of Isolated Systolic Hypertension

Isolated Systolic Hypertension

When high blood pressure isnt managed, it can cause damage to your arteries. This can affect many parts of your body and increase your risk of:

  • Heart attack. Elevated blood pressure can damage your coronary arteries, which increases the risk of a blockage in one of your hearts arteries.
  • Stroke. Untreated high blood pressure can damage or weaken the arteries in your brain, which increases the risk of an ischemic stroke, hemorrhagic stroke, and transient ischemic attack .
  • Heart failure. Elevated blood pressure can weaken the muscles of your heart, causing them to become too weak to pump blood efficiently to the rest of your body.
  • Aneurysm. High blood pressure can weaken part of an artery, causing it to bulge out and possibly rupture.
  • Kidney disease. The blood vessels in your kidneys can become damaged by untreated high blood pressure, resulting in your kidneys being unable to effectively filter toxins out of your blood.
  • Vision loss. Damage to the blood vessels in your eyes can lead to bleeding in the retina and loss of sight.
  • Dementia.Dementia or vascular dementia can occur when oxygen-rich blood flow to your brain is reduced.

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Open Access License / Drug Dosage / Disclaimer

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Systolic Blood Pressure Isolated Systolic Hypertension And Cardiovascular Risk


J Hypertens.J Hum Hypertens.

J Hypertens.JAMA.Am J Epidemiol.

Arch Intern Med.J Hypertens.

Eur Heart J.



Mutatis mutandisLancet.

Isolated systolic hypertension – Grade I 140-159
Isolated systolic hypertension – Grade II 160-179
Isolated systolic hypertension – Grade III 180 < 90

Eur Heart J.

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Isolated Systolic Hypertension: An Update After Sprint

  • Department of Cardiology, Mount Sinai St. Luke’s and Mount Sinai West Hospitals, New York, NYDepartment of Critical Care Medicine, Mayo Clinic, Rochester, Minn
  • Franz H. MesserliCorrespondenceRequests for reprints should be addressed to Franz H. Messerli, MD, Division of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, 1 Gustave L. Levy Pl, New York, NY 10029.Department of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, New York, NYUniversity Hospital, Bern, Switzerland

Clinical Characteristics Of Ish In The Young And Middle

Isolated Systolic Hypertension – Lightning Round

The 1999â2004 NHANES reported that obesity , male sex, education level less than high school, and current smoking were characteristics independently associated with higher odds of ISH among young- and middle-aged adults. The prevalence of obesity in the young- and middle-aged Americans with ISH was about 40%. In the HELIUS study, subjects with ISH had the greatest height, were younger, had a lower body mass index and cholesterol than those with SDH or IDH, while they were comparable in age, body mass index, and cholesterol with subjects having high-normal blood pressure. In the male Japanese workers and University students, the ISH participants had greater body mass index and waist circumference than participants with optimal blood pressure. In the ENIGMA study ISH subjects were taller, heavier, had a greater body mass index, and were more likely to be male, when compared with normotensive subjects.

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Consequences Of Isolated Systolic Hypertension

For young adults or those in their 50s, its important to monitor and treat blood pressure. Isolated systolic hypertension can cause the following:

Recent studies examined people aged from 40 to 89. They found for every 20 mm Hg increase in systolic blood pressure the risk of death from ischemic heart disease and stroke doubles 8.

Ischemic heart disease, also called coronary heart disease, is caused when the narrowed arteries in the heart receive less blood and oxygen which can lead to a heart attack.

Studies Addressing Whether Low Dbp Related To Worse Prognosis In Sh Is A High

As early as 1978, Anderson noted that, in the Framingham Heart Study data, when treating HTN, the benefit of sBP decrease was linear and continuous . Indeed, this is a motivation to further decrease sBP to lower values. In contrast, no importance was placed on diminishing dBP below approximately 90 mm Hg . This absence of an additional benefit of progressive dBP decrease explains, at least in part, a very important fact, i.e., why sBP has a more significant prognostic influence than dBP does. Subsequently, in 1979, Stewart demonstrated a > 5-fold increased mortality rate from MI associated with an excessive dBP decrease induced by drug treatment . The BP J-shaped curve debate started 40 years ago, and there is no indication that it will end in the near future. The J-shaped/U-shaped curve means that, for example, mortality is lower at the nadir and that both higher and lower values are associated with higher mortality.

In the vast majority of studies, the univariate association of low dBP with worse prognosis has been proved. In many studies, multivariate analysis is missing in others, results are conflicting regarding this J-curve relationship. Here, we analyze several important studies.

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It’s A Risk Factor That Needs Treatment Especially In The Over 50s

  • Ian B Wilkinson, lecturer in clinical pharmacology,
  • David J Webb Christison, professor,
  • John R Cockcroft, senior lecturer in cardiology
  • Clinical Pharmacology Unit, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU
  • Department of Cardiology, University Wales College of Medicine, Heath Park, Cardiff CF4 4XN
  • The association between hypertension and a hardening of the pulse and apoplexy has been recognised for hundreds of years. The major problem in elderly people is isolated systolic hypertension, defined as a raised systolic pressure but normal diastolic pressure. It affects around half of people aged over 60 years.1 Originally, because isolated systolic hypertension was so common it was considered part of ageing and, like essential hypertension, benign. However, there is now compelling evidence from cross sectional, longitudinal, and randomised controlled trials that show that isolated systolic hypertension confers a substantial cardiovascularrisk.23 Despite this, it remains underdiagnosed and largely untreated.4 The roots of this lie in a century of overreliance on the importance of diastolic pressure and largely unjustified concerns about the potential adverse consequences of treating systolic pressure.

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