Medically Reviewed by James Beckerman, MD, FACC on May 07, 2021 When your doctor takes your blood pressure, they’ll tell you two numbers: They’ll say the numbers as systolic pressure “over” diastolic pressure. For example, a healthy reading is below 120 over less than 80. If your systolic blood pressure is higher than 130 but your diastolic blood pressure is under 80, that’s called isolated systolic hypertension. It’s the most common kind of high blood pressure in older people. You probably won’t know you have it unless your doctor tells you -- there usually aren’t any noticeable signs of it until it causes serious health issues. That’s why high blood pressure is sometimes called “the silent killer.” 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 (when blood flow is limited or cut off to part of your brain). 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 don’t filter your blood the way they should. Older people are more likely to have it, because systolic blood pressure usually goes up as you age. 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: Your doctor also may recommend you do a few other things:
A. This question comes up often, perhaps because doctors and patients alike tend to pay more attention to the top (first) number, known as systolic pressure. It reflects the amount of pressure inside the arteries as the heart contracts. The bottom (second) number, diastolic pressure, is always lower since it reflects the pressure inside the arteries during the resting phase between heartbeats. As it turns out, both systolic and diastolic blood pressure are important. Per the most recent guidelines, you have what's called elevated blood pressure if your systolic blood pressure reading is 120 to 129 mm Hg (which stands for millimeters of mercury). Once your systolic reading reaches 130 or higher or your diastolic reading is 80 or higher, you're considered to have high blood pressure, or hypertension. Most people have what's known as essential or primary hypertension, which means it's not caused by a medical condition, medication, or substance. Primary hypertension can affect both systolic and diastolic pressure to a similar degree. But sometimes, especially in older people, it affects mainly the systolic pressure; this is called isolated systolic hypertension. Why does this happen? As you age, your arteries tend to become less elastic and less able to accommodate surges of blood. Blood flowing through your arteries at high pressure can damage the inner lining of these vessels, accelerating the buildup of cholesterol-laden plaque. This further stiffens and narrows the arteries, a condition known as atherosclerosis. Because the same volume of blood has to pass through a smaller area, the systolic pressure tends to rise, while the diastolic pressure remains the same or gradually falls over time. In some people with isolated systolic hypertension, the diastolic pressure reading may drop into the 50s or even the 40s. Most studies show a greater risk of cardiovascular disease (especially strokes) related to high systolic pressure as opposed to elevated diastolic pressure. But in 2019, an eight-year-long study involving more than 1.3 million adults found that while elevated systolic pressure had a greater effect on cardiac outcomes, high diastolic readings also affected a person's risk, regardless of the systolic reading. To ensure accurate readings when you're checking your blood pressure at home, be sure to sit comfortably with your back supported, your feet flat on the floor, and your arm resting on a table with your palm facing up. If needed, support your arm with a pillow so that your elbow is at the level of your heart. — Deepak L. Bhatt, M.D., M.P.H. Image: © Vadim Zhakupov/Getty Images
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ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS
Blood pressure is the force of the blood pushing against the artery walls. The force is made with each heartbeat as blood is pumped from the heart into the blood vessels. This is called systolic blood pressure. Blood pressure is also affected by the size of the artery walls and their elasticity. Each time the heart beats (contracts and relaxes), pressure is created inside the arteries. When the heart is relaxed, the arteries stay at a lower resting tone to maintain some pressure in the artery. This is called diastolic blood pressure. High blood pressure is when the force of the blood is too high during heart contraction or relaxation within the arteries. The arteries may have an increased resistance against the flow of blood. This causes your heart to pump harder to circulate the blood.
These factors may cause high blood pressure:
More than half of all adult Americans have high blood pressure. You are at risk for it if you:
High blood pressure often has no symptoms. But you can find out if your blood pressure is higher than normal by checking it yourself or by having it checked regularly by your healthcare provider. Very high blood pressure can cause symptoms. These include headache, changes in vision, or chest pain.
Blood pressure is measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider. You can also take your own blood pressure with an electronic blood pressure monitor. You can find one at most pharmacies.
 Two numbers are recorded when measuring blood pressure:
Both the systolic and diastolic pressures are recorded as mm Hg (millimeters of mercury). This recording represents how high the mercury column in the blood pressure cuff is raised by the pressure of the blood. Blood pressure is rated as normal, elevated, or stage 1 or stage 2 high blood pressure:
Even higher blood pressure (with the systolic blood pressure 180 or higher, the diastolic blood pressure more than 120, or both) is called a hypertensive urgency if there are no related symptoms. Or it's called a hypertensive emergency if there are symptoms indicating damage to the brain, heart, or kidneys. If you have a hypertensive urgency, you may need a change in your medicine right away or be evaluated in an emergency room. If you have a hypertensive emergency, you will need to be evaluated in an emergency room; and likely have a stay in the hospital. A single higher blood pressure measurement does not always mean you have a problem. Your healthcare provider will want to see several blood pressure measurements over a number of days or weeks before diagnosing high blood pressure and starting treatment. Ask your provider when you should call if your blood pressure readings are not in the normal range.
Treatment for high blood pressure may involve: Lifestyle changes
These healthy steps can help you control your blood pressure:
Certain medicines
Sometimes you may need to take 1 or more daily medicines to control high blood pressure. Take it exactly as directed. If you have high blood pressure, have your blood pressure checked routinely and see your healthcare provider to watch the condition.
High blood pressure raises your risk for:
You can help prevent high blood pressure with many of the same healthy steps used to treat it. These are:
Key points about high blood pressure
Tips to help you get the most from a visit to your healthcare provider:
Medical Reviewer: Steven Kang MD Medical Reviewer: Ronald Karlin MD Medical Reviewer: Stacey Wojcik MBA BSN RN © 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. |
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