High blood pressure has long been linked with bad heart outcomes. But research just released from the University of Alabama at Birmingham indicates that older adults with a low diastolic (the bottom number) and a high upper number face greater odds of developing new-onset heart failure. Show The findings are published in Hypertension, a journal of the American Heart Association. The association describes heart failure as a weakened heart muscle that can no longer pump hard enough to provide adequate blood to the body's cells. It notes that symptoms include fatigue and shortness of breath and trouble with everyday activities. With heart failure, the heart muscle can't pump adequate blood to meet the body's needs for blood and oxygen. It tries to compensate by enlarging so it can pump more blood, growing thicker muscle mass and pumping faster. The blood vessels try to be helpful, too, narrowing to keep blood pressure up. And the body diverts blood to the heart and brain, since they are the most vital organs, but that shorts the supply needed by other tissues and organs. Eventually, it can't mask what's happening, but sometimes people do not know for months or even years that their hearts are failing because of those masking "helps." Blood pressure is a mathematical formula that looks at the pressure exerted on vessels when the heart is beating "over" the pressure in blood vessels between beats — 120/80 is considered optimal. The researchers coined the term "isolated diastolic hypotension" to describe a condition where the diastolic or between-beat pressure is less than 60 mm Hg and the systolic blood pressure is not low, measured at above 100 mm Hg. The researchers said it's similar to a condition called isolated systolic hypertension, when the systolic blood pressure alone is elevated (above 140 mm Hg), but the diastolic is not elevated. That is common in older adults and it, too, increases the risk one will experience heart failure. "Our findings showed that older adults who have low diastolic blood pressure but not low systolic blood pressure were more likely to develop new-onset heart failure than those with higher levels of diastolic blood pressure," said Dr. Ali Ahmed, study senior investigator, professor of medicine in the Division of Gerontology, Geriatrics and Palliative Care and also director of Alabama's geriatric heart-failure clinic. "Older adults with low diastolic blood pressure also had higher risk of death." The researchers found that those who control their high systolic blood pressure with medications can also develop isolated diastolic hypotension. The trick for some doctors will be figuring out how to prescribe medications to reduce the elevated systolic blood pressure without taking the diastolic blood pressure down too far as well, said study lead author Dr. Jason Guichard, a cardiology fellow. "Unfortunately, when the diastolic blood pressure is low in the absence of any antihypertensive medications, there is little that can be done," Ahmed said in a release accompanying the study. "Whether addressing other risk factors for heart failure would reduce the risk of heart failure in these individuals remains unclear." The study included 545 older adults with isolated diastolic hypotension and 2,348 "propensity-matched" older adults without the condition, balanced on 58 baseline characteristics that included traditional risk factors for heart failure. They were all part of the Cardiovascular Health Study, a large population-based study of Medicare-eligible older adults recruited between 1992-93, who were followed for more than a dozen years. This study was funded by the National Heart, Lung and Blood Institute. EMAIL: Isolated systolic hypertension is a type of high blood pressure. A healthcare professional may diagnose it if systolic blood pressure is more than 130 mm Hg and diastolic blood pressure is less than 90 mm Hg. Isolated systolic hypertension is most common in older adults, but it can also affect younger adults. It is often asymptomatic but can cause serious complications without treatment. This article discusses what isolated systolic hypertension is, its symptoms, causes, and treatment options. It also examines whether the relevant authorities consider it a disability. When blood circulates throughout the body, it puts pressure on the artery walls. This is known as blood pressure. As part of a health checkup, a technician may check a person’s blood pressure. A blood pressure reading provides two numbers known as systolic, which is the upper or first number, and diastolic, which is the lower or second number. A person has high blood pressure when the numbers rise above the normal range. Isolated systolic hypertension occurs when just the systolic number is high. Isolated systolic high blood pressure is a cause for concern, and a person needs to address it. Over time, untreated systolic hypertension can lead to several serious complications. A 2021 article notes that systolic hypertension occurs most often in older people. About 30% of people over the age of 60 experience this type of hypertension. Younger adults have a significantly lower chance of experiencing systolic hypertension. About 6% of those aged 40–50 and 1.8% of those aged 18–39 are living with the condition. However, according to research from 2016, young adults with high blood pressure or systolic hypertension have an increased risk of developing heart disease or dying. Isolated systolic hypertension has the same general causes as regular high blood pressure. Some potential causes and risk factors include:
A person is also more likely to develop high blood pressure as they get older. In addition, Black people are more likely to develop high blood pressure. Learn more about hypertension in African Americans here. In rare cases, it may occur as a result of other conditions, such as:
In 2017, the American Heart Association (AHA) changed the classification for isolated systolic high blood pressure from any number over 140 millimeters of mercury (mm Hg) to any reading over 130 mm Hg. A single high reading or isolated readings above 130 mm Hg do not necessarily mean a person should be concerned. According to the CDC, a doctor may diagnose high blood pressure if a person’s systolic blood pressure is consistently above 130 mm Hg. However, some practices use the early standard of 140 mm Hg for systolic pressure to diagnose hypertension. In those cases, a doctor may still recommend taking steps to help reduce blood pressure, even if they cannot diagnose the condition. Treating isolated systolic hypertension involves a combination of lifestyle changes and medical interventions. According to the AHA, the most important steps a person can take to treat or prevent high blood pressure include:
A person may also find it beneficial to follow the DASH diet to help reduce high blood pressure. A healthcare professional can recommend medications such as:
Within 8–10 years, 30% of those with mild to moderate high blood pressure have a higher chance of developing atherosclerosis disease, which is when plaque builds up in the arteries. Organ damage may occur in 50% of people. Without treatment, isolated systolic hypertension may lead to:
Not all cases of isolated systolic hypertension will qualify for disability benefits. Like other conditions, a person would need to demonstrate that their condition impacts their ability to work. In some cases, the authorities do not consider high blood pressure a disability, but an underlying cause could be. For example, the Social Security Administration (SSA) does not mention hypertension as a qualifying condition, but several conditions that can lead to hypertension appear in its listings as possible reasons to apply for disability benefits. The Department of Veterans Affairs does allow a veteran with isolated systolic hypertension to apply for disability benefits through its office. However, similar to the SSA, a person needs to meet certain criteria to qualify. A person diagnosed with isolated systolic hypertension who believes they can no longer work should speak with a doctor. A doctor can help advise the person on whether or not they may qualify for benefits. A person is unlikely to know they have isolated systolic hypertension because it often does not cause any symptoms. A doctor may diagnose isolated systolic hypertension based on a few high blood pressure readings over the course of a few to several visits. A person undergoing treatment for high blood pressure or who is at risk of high blood pressure should consider monitoring it at home regularly. They should contact a doctor if their treatment methods are not working or their blood pressure starts to go up. Isolated systolic hypertension is a form of high blood pressure. Though it is most common in older adults, it can occur in younger adults and may increase a younger person’s risk of heart disease or death. Symptoms typically do not occur. Treatment typically involves monitoring blood pressure, medications, and lifestyle changes. A person should talk with their doctor if treatment steps do not help. Read this article in Spanish. Why is my systolic pressure high but diastolic is normal?Isolated systolic hypertension is when your systolic blood pressure is high, but your diastolic blood pressure is normal. It can occur naturally with age or can be caused by specific health conditions, including anemia, diabetes, and hyperthyroidism.
What causes the systolic pressure to be high?High systolic blood pressure can have many causes. As we age, our arteries stiffen, and over time this contributes to high blood pressure. The genes we inherit also can cause high blood pressure. Certain underlying conditions like thyroid disease, cortisol excess, and obesity can also cause high blood pressure.
Which is more serious high systolic or diastolic?Over the years, research has found that both numbers are equally important in monitoring heart health. However, most studies show a greater risk of stroke and heart disease related to higher systolic pressures compared with elevated diastolic pressures.
What is dangerously high systolic blood pressure?Your blood pressure is considered high (stage 1) if it reads 130/80. Stage 2 high blood pressure is 140/90 or higher. If you get a blood pressure reading of 180/110 or higher more than once, seek medical treatment right away. A reading this high is considered “hypertensive crisis.”
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What does it mean when systolic is high and diastolic is low
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