Isolated Systolic Hypertension: Causes and Treatments | MyHeartDiseaseTeam

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Isolated Systolic Hypertension: Causes and Treatments

Medically reviewed by Steven Kang, M.D.
Written by Simi Burn, PharmD
Posted on February 8, 2023

Isolated systolic hypertension is the most common form of hypertension (high blood pressure) in older people and is a major risk factor for cardiovascular disease (heart disease). If you’ve been diagnosed with isolated systolic hypertension, your doctor may talk to you about medications and lifestyle changes to treat your condition.

What Is Isolated Systolic Hypertension?

When your medical provider checks your blood pressure, they measure two numbers. The first number — your systolic blood pressure — measures the pressure in your arteries when your heart beats. The second number — your diastolic blood pressure — measures the pressure in your arteries between beats, when your heart rests. Your medical provider will tell you your blood pressure reading as systolic “over” diastolic.

Normal blood pressure is a systolic blood pressure of less than 120 millimeters of mercury (mm Hg) and a diastolic blood pressure of less than 80 mm Hg. If your systolic blood pressure is higher than 130 mm Hg, but your diastolic blood pressure is less than 80 mm Hg, it’s called isolated systolic hypertension.

Isolated Systolic Hypertension Causes and Risk Factors

Heart conditions such as heart valve disease and artery stiffness can lead to isolated systolic hypertension. Other causes include health conditions like diabetes, hypothyroidism (underactive thyroid), and obesity.

Some people, including older people — specifically, women and Black people — have a higher risk of developing isolated systolic hypertension, according to a study published in The American Journal of Medicine. However, younger and middle-aged people can also develop isolated systolic hypertension.

Lifestyle factors such as the following can increase your risk of high blood pressure generally:

  • Eating a high-sodium (high-salt) diet
  • Getting too little exercise
  • Drinking too much alcohol
  • Smoking tobacco

It’s important to have your doctor monitor your blood pressure. High blood pressure is sometimes called “the silent killer” because you probably won’t know you have it unless your medical provider tells you. Even without noticeable symptoms, hypertension can raise the risks of stroke, other types of heart disease, and chronic kidney disease.

How Is Isolated Systolic Hypertension Treated?

Lowering high blood pressure is important to reduce your risk of serious illnesses, such as heart disease, heart attack, and stroke. If you are diagnosed with isolated systolic hypertension, your health care provider may prescribe medication or recommend lifestyle changes.

Medications

Several types of drugs can treat high blood pressure. Your doctor may prescribe one or more medications for isolated systolic hypertension that work in different ways to help bring your blood pressure down. They’ll choose the best treatment option depending on your individual health needs — and you might need more than one type of drug.

If your doctor prescribes blood pressure medication, it’s important that you take it exactly as directed. Some medications should not be crushed, chewed, or cut in half. Don’t make changes or stop taking your medication without talking to your medical provider first.

Diuretics

Sometimes called “water pills,” diuretics help your body get rid of extra water and salt through your urine. Diuretics are often the first medication prescribed for isolated systolic hypertension.

The three types of diuretics — thiazide, loop, and potassium-sparing — work on different parts of your kidneys.

Thiazide diuretics include:

Loop diuretics include:

Potassium-sparing include:

A common side effect of diuretics is increased urination, so you may find yourself going to the bathroom more frequently. One MyHeartDiseaseTeam member said, “My doctor prescribed a water pill, and it’s causing me to run to the bathroom all day long!” Other side effects of diuretics include dizziness, dehydration, and electrolyte changes in your blood.

If a diuretic doesn’t lower your blood pressure enough on its own, your doctor may add other medications.

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by causing blood vessels to relax. They work by blocking ACE to prevent the production of angiotensin 2 (sometimes written in Roman numerals as angiotensin II), a substance that causes blood vessels to tighten.

Some examples of ACE inhibitors are:

Side effects of ACE inhibitors include headache, dizziness, fatigue, dry cough, and hyperkalemia (high potassium in your blood). In rare cases, ACE inhibitors can cause angioedema (facial and airway swelling), which is a serious medical emergency. ACE inhibitors should not be used during pregnancy.

Angiotensin-Receptor Blockers

Angiotensin-receptor blockers (ARBs) also lower blood pressure by relaxing your blood vessels but work in a different way. ARBs, such as the following, hold back the activity of angiotensin 2:

Side effects of ARBs include headache, dizziness, fatigue, and hyperkalemia. These drugs should not be used during pregnancy.

Calcium Channel Blockers

Calcium channel blockers reduce blood pressure by keeping calcium out of the heart’s cells and arteries, allowing blood vessels to relax and open. This class of drugs includes:

Calcium channel blockers can lead to side effects such as dizziness, upset stomach, fatigue, and swelling of your ankles or legs.

Beta-Blockers

Beta-blockers help your heart beat more slowly and with less force. However, these drugs aren’t the preferred first-line treatment for high blood pressure in people over 60 — they don’t work as effectively in older adults as they do in younger people.

Examples of beta-blockers include:

Common side effects of beta-blockers include fatigue, headache, stomach upset, and dizziness. In rare cases, beta-blockers can cause slow heartbeat, confusion, or problems with breathing.

Lifestyle Changes for High Blood Pressure

Making certain lifestyle changes may help control blood pressure. If you have high blood pressure, your doctor may recommend that you adopt some healthy habits. You might be advised to:

  • Eat a diet rich in a variety of healthy foods, like fresh fruits and vegetables, whole grains, and lean protein.
  • Reduce your intake of saturated fat and sodium.
  • Stop smoking tobacco or using nicotine.
  • Limit alcohol (if you drink) to no more than two drinks per day for men and no more than one per day for women, according to the Centers for Disease Control and Prevention (CDC).
  • Achieve or maintain a healthy weight.
  • Exercise regularly for about 30 minutes a day, five days a week, choosing moderate-intensity activities such as brisk walking, swimming, or bicycling.
  • Get enough sleep.
  • Reduce and manage stress.

MyHeartDiseaseTeam members encourage each other in making heart-healthy lifestyle changes. One member said, “Stick with that diet. It’s tough at times but worth it.” Another wrote, “Some days we get the exercise we need, and some days we just can’t for whatever reason. Just don’t beat yourself up. Do what you can when you can, and just take the best care of yourself possible.”

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 56,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you living with isolated systolic hypertension? Are you taking any medications or making lifestyle changes to help manage your condition? Share your experience and tips in the comments below or by posting on your Activities page.

    Posted on February 8, 2023
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    Steven Kang, M.D. is the Director of Cardiac Electrophysiology at Alta Bates Summit Medical Center and Alameda Health Systems in Oakland, California. Learn more about him here.
    Simi Burn, PharmD is a seasoned pharmacist with experience in long-term care, geriatrics, community pharmacy, management, herbal medicine, and holistic health.. Learn more about her here.

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