From the Guidelines
A high systolic blood pressure with a low diastolic pressure indicates isolated systolic hypertension, which is a condition that increases the risk of cardiovascular events, particularly stroke, and requires treatment to reduce systolic pressure and manage symptoms. This condition is characterized by a widened pulse pressure, which reflects decreased arterial compliance and increased arterial stiffness, placing additional strain on the heart and blood vessels 1. According to the 2007 guidelines for the management of arterial hypertension, isolated systolic hypertension should be graded (1,2,3) according to systolic blood pressure values, and the association with a low diastolic blood pressure should be regarded as an additional risk 1.
Key Points to Consider
- Isolated systolic hypertension is common in older adults and occurs when arteries stiffen with age, causing the systolic pressure to rise while diastolic remains normal or low.
- Treatment typically involves lifestyle modifications such as reducing sodium intake, maintaining a healthy weight, regular exercise, limiting alcohol, and quitting smoking.
- Medications may include thiazide diuretics, calcium channel blockers, or ACE inhibitors, with the goal of bringing systolic pressure below 130 mmHg while monitoring for symptoms of low diastolic pressure.
- The widened pulse pressure reflects decreased arterial compliance and increased arterial stiffness, which places additional strain on the heart and blood vessels, and increases the risk of cardiovascular events, particularly stroke.
Importance of Accurate Blood Pressure Measurement
Accurate blood pressure measurement is crucial in diagnosing and managing isolated systolic hypertension, as emphasized in the recommendations for blood pressure measurement in humans and experimental animals 1. The gold standard for clinical blood pressure measurement is readings taken by a trained health care provider using a mercury sphygmomanometer and the Korotkoff sound technique, but there is increasing evidence that this procedure may lead to the misclassification of large numbers of individuals as hypertensive. Therefore, it is essential to follow established guidelines for blood pressure measurement to ensure accurate diagnosis and treatment of isolated systolic hypertension.
From the Research
Blood Pressure Readings
A blood pressure reading with a high systolic and low diastolic value can be an indication of a potential health issue.
- High systolic blood pressure is associated with an increased risk of heart failure, myocardial infarction, cerebrovascular disease, and death 2.
- Low diastolic blood pressure, on the other hand, may jeopardize coronary perfusion and predispose to new acute coronary events, especially if the diastolic pressure drops excessively 3.
Implications of High Systolic and Low Diastolic Blood Pressure
- The combination of high systolic and low diastolic blood pressure may be seen in certain patient populations, such as those with a history of hypertension and acute myocardial infarction 3.
- In these patients, antecedent hypertension is associated with higher rates of death and morbid events, particularly if complicated by left ventricular dysfunction and/or congestive heart failure 3.
- However, higher systolic pressure at the onset of chest pain may associate with lower mortality within 1 year from coronary occlusion 3.
Treatment Considerations
- Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years 2.
- A blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 2.
- Renin-angiotensin-aldosterone system blockade may exert particular benefits in high-risk hypertensive subgroups 3.