Isolated systolic hypertension is defining as raised systolic blood pressure over 140 mmHg. However, diastolic stays below 90 mmHg.
What is isolated systolic hypertension (ISH)?
ISH is the most common form of hypertension in those older than 65 years. Obesity and smoking appear to be important determinants of ISH among young adults.
For years, doctors show importance only on diastolic blood pressure. It is because they thought; our body could tolerate an occasional increase in systolic BP than consistently elevated diastolic and may lead to health problems. However, now doctors know that raised systolic BP is as important as high diastolic and even great significance in the case of older people over 50 years.
Causes of isolated systolic hypertension
ISH reflects progressive structural and functional decline of the arterial wall causing endothelial dysfunction, atherosclerosis, aortic stiffness and increased wall stress and pulse pressure.
Certain medical conditions can contribute to the development of isolated systolic hypertension. These medical conditions include anemia, overactive thyroid or adrenal gland, a malfunctioning aortic valve, kidney disease, and even obstructive sleep apnea. Usually, it is the result of age-related stiffening of the large arteries.
Aging makes the artery walls stiffen and make the diastolic blood pressure to drop, while systolic pressure to rise. Diastolic pressure usually tends to drop after 50 years of age. However, systolic continues to increase throughout the life.
Effects of Isolated Systolic Hypertension
The combination of higher systolic and lower diastolic blood pressures (widening of pulse pressure) is a major cardiovascular risk in the elderly.
It should come as no surprise because the widening pulse pressure reflects atherosclerotic stiffening of the aorta and large capacitance vessels. The dangers of high systolic pressure are well known, and unequivocal evidence shows that the treatment of ISH provides significant protection against cardiovascular mortality and morbidity.
7 Lifestyle changes for isolated systolic hypertension.
Everyone with hypertension can benefit with lifestyle changes; there is no exception in the case of isolated systolic hypertension. Mild levels of elevated systolic BP can manage effectively with lifestyle modification as the only treatment.
- Weight loss - Losing 1.0 kg (2 pounds) body weight decreases blood pressure by 1.6/1.3 mmHg. It improves insulin sensitivity, sleep apnea, and decreased sodium sensitivity.
- Dietary sodium restriction - Moderate degrees of sodium restriction to 2.4 grams/day can reduce SBP by 2 to 8 mm Hg.
- Healthy diet changes - The diet rich in fruits, vegetables, low total fat, and high fiber can reduce SBP by 8 to 14 mm Hg.
- Moderation of alcohol – Limiting the consumption to 2 drinks per day for men and one drink per day for women may lower SBP by 2 to 3 mmHg.
- Stop tobacco use - It is a significant contributor to ISH and other detrimental effects on other body systems.
- Physical exercise - brisk walking for 30 minutes on most days of the week results in SBP reduction by 4 to 9 mm Hg.
- Stress management - Relaxation techniques such as meditation, yoga, reflexology, tai chi, and massage can reduce blood pressure.
When to start drug treatment for systolic hypertension?
A wide pulse pressure characterizes isolated systolic hypertension is an important entity requires consistent treatment. In addition to lifestyle changes, drug treatment is emphasizing in the majority cases of ISH.
Before rushing to drug treatment, you should rule out white coat hypertension effects. A study shows the average systolic value of the participants taken in the office is 173 mmHg. However, almost 25 % of participates ambulatory or home systolic BP was less than 140 mmHg, and another 45 % has less than 160 mmHg. So it has confirmed that most of the participant has white coat syndrome. Additionally, increasingly strong evidence shows that those with white coat hypertension do not experience an increase in cardiovascular events for at least ten years.
A systolic blood pressure less than 160 mmHg in the absence of obvious target organ damage or overt cardiovascular disease should not require medication treatment instead require lifestyle changes.
However, if there is any target organ damage or overt cardiovascular disease that would mandate drug therapy, even if a significant white-coat effect is available.
Danger of low diastolic in ISH
Lowering of diastolic during treatment of systolic hypertension consider harmful. Thus you need to be caution in the treatment.
The dangers of high systolic are well known, and evidence shows that the ISH treatment provides significant protection against cardiovascular mortality and morbidity.
A study shows there is an increase in mortality with progressively lowering of diastolic pressures. When diastolic pressures are lower too much with hypertension medication treatment, similar increases in death have noted. Therefore, the high systolic pressure must lower, but caution is requiring not lowering the already low diastolic pressure much further.
Isolated systolic hypertension medicinal treatments.
The goal of isolated systolic hypertension (ISH) treatment should be gentle to bring your systolic-BP to near 140 mmHg while ensuring not to lower your diastolic pressure much below 70 mmHg.
In the Framingham study the participants being treated for hypertension, 90 % had achieved a diastolic BP target of below 90 mm Hg, while only 49 % were at a systolic BP target of below 140 mm Hg.
Isolated systolic hypertension without other compelling indications needs to follow hypertension lifestyle changes along with mono-therapy. Various studies indicate that low‐dose thiazide diuretics and slow/long‐acting calcium antagonists are the drugs of first-line medication choice for ISH.
A slow lowering of systolic pressure is mandatory in case of elderly patients. A target SBP level of around 140 mmHg seems desirable. Newer drugs such as ACE‐inhibitors, AT1‐blockers, and omapatrilat are considering effective in lowering systolic in ISH patients.
Spironolactone can control the arterial stiffness which is the basis of ISH. Nitrates as NO generator may be considered as a potential new agent to treat ISH. Isosorbide dinitrate took eight weeks of treatment to show this effect on SBP. Transdermal nitroglycerine and molsidomine demonstrated a similar effect.