What is Systolic Hypertension?
Isolated systolic hypertension is a common type of high blood pressure among the elderly. Traditionally, it’s defined as a high top number (over 140 mm Hg) in a blood pressure reading and a normal bottom number (below 90 mm Hg). About 15% of people aged 60 and up have this type of high blood pressure. However, in 2017, the American College of Cardiology and the American Heart Association changed their blood pressure guidelines. Now, a top number of 130 mm Hg is considered high for people of all ages. This new definition will likely result in more elderly people being diagnosed with high blood pressure. It’s important to keep an eye on this issue, as persistently high blood pressure can lead to serious health problems if left untreated.
What Causes Systolic Hypertension?
Many people with high blood pressure mainly have what’s known as primary or essential hypertension. However, sometimes high blood pressure affecting only the systolic (upper) reading can be due to other health issues, which are then known as secondary hypertension. These can include thyroid disease, chronic kidney disease, circulation problems, diabetes, aortic valve disease, abnormal connections between arteries and veins, anemia, Paget’s disease, and narrow arteries to the kidneys.
Risk Factors and Frequency for Systolic Hypertension
Isolated systolic hypertension, a type of high blood pressure, is common in elderly individuals. Research suggests that about 30% of people over the age of 60 experience untreated isolated systolic hypertension. This is higher compared to 6% of adults aged 40-50, and only 1.8% of young adults aged 18-39. It’s also worth noting that according to a health study, a 65-year-old person with normal blood pressure has a 90% chance of developing high blood pressure in their lifetime. Also, amongst older age groups, women and non-Hispanic black individuals tend to have higher rates of high blood pressure disorders.
Signs and Symptoms of Systolic Hypertension
Isolated systolic hypertension is a type of high blood pressure that can cause significant health problems if not treated. It’s important to detect it early on, address any risk factors that can be modified, and start treatment to reduce the risk of further illness and death. Things to consider when investigating high blood pressure include:
- Intake of certain substances like nonsteroidal anti-inflammatory drugs, steroids, stimulants, cocaine, estrogen
- Risk factors like smoking, diabetes, abnormal cholesterol levels, obesity, inactivity, unhealthy diet
- Diet, including high salt, processed food, high fat, and alcohol intake
- Family history of high blood pressure, kidney disease, diabetes, or heart disease
- Symptoms of secondary causes such as periods of shaking, sweating or rapid heart rate, muscle weakness, skin thinning, depression, blood in urine, loud snoring, excessive daytime sleepiness
- Symptoms of damage to target organs like headaches, loss of visual sharpness, shortness of breath, chest pain, leg pain when walking
During a physical examination, it’s important to accurately measure your blood pressure and to assess other physical characteristics:
Accurate Blood Pressure Measurement
- Re-evaluate normal blood pressure yearly.
- Measure blood pressure after resting for five minutes.
- The patient should sit with both feet flat on the ground and their back straight.
- The patient’s arm should be on a flat surface level with the chest or heart.
- It’s important to use the correct cuff size.
- Systolic blood pressure is the first sound heard when measuring.
- Diastolic blood pressure is the fifth sound heard.
- A hypertension diagnosis is confirmed after averaging 2 to 3 blood pressure measurements from two or three different visits.
Additional physical signs to be aware of include:
- Calculate body mass index
- Signs of Cushing syndrome like fat accumulation on the back of the neck, round face, thinning skin, and red or purple stretch marks
- Restlessness
- Sweating
- Flushing
- Indications of Neurofibromatosis
- Swelling of the thyroid
- Noises in the carotid artery in the neck during examination
- Changes in the back of the eye such as swelling of the optic disc, white patches, narrowing of small arteries, changes at the bend of arteries and veins, bleeding
- Heart sounds indicating underlying issues
- Signs of heart problems such as jugular vein distension
- Abnormal sounds in the lungs
- Enlarged kidneys
- Noises of blood flow in the large arteries or kidneys during examination
- Changes in vision
- Confusion
- Focal weakness
- Checking the pulsations in the peripheral body parts
- Swelling in the foot/leg
- Cold peripheral limbs
Testing for Systolic Hypertension
If someone may have high blood pressure when the heart pumps (this is known as systolic hypertension), doctors need to do more tests. They’ll want to check:
- Whether there are factors that could increase the risk of heart diseases
- The extent to which organs have been damaged
- What might be causing the high blood pressure
- Any other health conditions that might affect health outcomes and treatment approach
In order to assess the risk of cardiovascular disease and other diseases present at the same time, these tests may be carried out:
- An EKG (12-lead electrocardiograph) to check for signs of heart enlargement and irregular heart rhythms
- Blood tests to assess cholesterol levels and risk of heart disease over the next 10 years
- Blood tests to check kidney function and levels of sodium and potassium
- A test to check the function of the thyroid gland
- Urine tests to check for protein, which could be a sign of kidney disease
Based on the results of these tests, medical history, and a physical examination, the following tests may also be needed:
- A blood test to check long-term blood sugar control
- A blood test for uric acid which is linked to gout
- A test that compares blood pressure in your ankle with blood pressure in your arm
- Sonograms of the kidneys and blood vessel tests in the kidneys
- Urine tests to measure the amount of protein, indicating possible kidney damage
- An ultrasound of the heart (echocardiogram) if heart failure is suspected
- Specific tests to check for less common causes of high blood pressure like certain hormones (cortisol, aldosterone, etc.)
Treatment Options for Systolic Hypertension
The 2017 ACC/AHA guidelines classified blood pressure as follows:
Normal Blood Pressure is when your Systolic Blood Pressure (SBP, the “top” number) is less than 120 mmHg, and your Diastolic Blood Pressure (DBP, the “bottom” number) is less than 80 mmHg. If this is your reading, it’s recommended to keep up with healthy lifestyle habits.
Elevated Blood Pressure is when your SBP is between 120 and 129 mmHg and your DBP is less than 80 mmHg. For this, it’s suggested to start non-drug treatments and recheck your blood pressure in three to six months.
Hypertension (or high blood pressure) comes in two stages. Stage 1 is when your SBP is between 130 and 139 mmHg or your DBP is between 80 and 89 mmHg. Depending on whether you have conditions that increase your risk of heart disease (ASCVD), the treatment will vary:
– Patients without ASCVD are advised to start non-drug treatments and get checked in three to six months.
– Patients with ASCVD should do the above, plus start taking one blood pressure drug and get checked after one month.
Hypertension Stage 2 is when your SBP is above 139 mmHg or your DBP is less than 89 mmHg. At this stage, it’s recommended to start non-drug treatments, along with blood pressure medication, and get checked in a month.
Regardless of the stage, if the blood pressure goals are not met, the doctor may recommend checking medication adherence or possibly increasing the treatment. Otherwise, regular checkups every three to six months are recommended.
As for treatment, it’s divided into non-drug and drug therapies:
Non-drug treatments are advised for all patients, regardless of their blood pressure. This includes limiting salt intake, losing weight (losing 1 lb can reduce blood pressure by 1 mmHg), following the DASH diet (rich in fruits, veggies, whole grains, fish, and low-fat dairy), increasing physical activities, limiting alcohol, taking potassium supplements, quitting smoking, and managing stress.
Drug treatments typically start with one blood pressure drug, particularly for the elderly to avoid a sudden decrease in blood pressure when standing. Some of the common classes of these drugs include thiazide-like diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers.
As for blood pressure goals, different studies recommend different targets:
– Two major clinical trials recommend keeping SBP under 150 mmHg by using medication.
– The VALISH trial found no significant difference when comparing strict (SBP under 140 mmHg) and moderate (SBP 140-150 mmHg) control of blood pressure. However, the trial’s sample was relatively small, making the results less reliable.
One recent study suggested that a target of SBP under 120 mmHg has improved outcomes and overall survival compared to a target of 135-139 mmHg. However, aggressively reducing SBP may lead to adverse effects, such as low blood pressure or organ damage, especially among the elderly. So, it is advisable to keep blood pressure under 130/80 mmHg if possible, but keeping it under 140/90 mmHg is considered reasonable for the elderly and those with unstable blood pressure or on multiple medications.
Finally, the treatment approach should be patient-centered, focusing on the best blood pressure control and avoiding multiple medications, especially for the elderly. It’s important to note that overly strict blood pressure control may cause a sharp decrease in DBP, which might increase the risk of heart complications and death, and this is known as the “J-curve” phenomenon.
What else can Systolic Hypertension be?
It’s essential to correctly determine whether someone has white coat hypertension, masked hypertension, or pseudo-hypertension. If these conditions are misdiagnosed, it could lead to over-treatment or under-treatment of high blood pressure, which could lead to serious health risks.
White coat hypertension is when someone’s blood pressure level is higher when checked in a medical setting, like a doctor’s office, but it’s normal when they measure it elsewhere, like at home.
Masked hypertension is the exact opposite. It is when someone’s blood pressure is normal during a check-up at the doctor’s office, but it’s consistently high when they measure it at home or in places outside the medical setting.
Pseudo-hypertension is a different scenario where the blood vessels become hardened, and the regular blood pressure cuff cannot accurately measure the pressure inside the blood vessels. This hardening of vessels can give a false high blood pressure reading. One way to distinguish pseudo-hypertension from real high blood pressure is by standing while having your blood pressure measured. Patients whose blood pressure remains difficult to control should be checked for pseudo-hypertension before being officially labeled as having resistant hypertension (a type of high blood pressure that’s hard to control).
What to expect with Systolic Hypertension
Mild to moderate high blood pressure, if not treated, can put about 30% of people at risk of developing artery disease and could cause organ damage in 50% of people within 8-10 years after it starts. Those with high blood pressure that’s difficult to control are at an increased risk for dangerous health events, especially if they also have related health conditions like chronic kidney disease or heart disease.
However, patients with hard-to-control high blood pressure who succeed in lowering their blood pressure seem to have a lower chance of experiencing certain heart-related problems, such as stroke, disease of the heart’s arteries, or heart failure.
Possible Complications When Diagnosed with Systolic Hypertension
If high systolic blood pressure isn’t managed properly, it can result in a number of serious health problems:
- Stroke
- Myocardial infarction (heart attack)
- Heart failure
- Peripheral vascular disease (circulation disorder that affects blood vessels outside of the heart and brain)
- Aneurysm (a bulge in the wall of your artery)
- Chronic kidney disease
- Eye damage (Retinopathy)
- Erectile dysfunction
Preventing Systolic Hypertension
Hypertension, commonly known as high blood pressure, is a long-term health condition that can be managed effectively with both lifestyle changes and medical treatments. Lifestyle modifications can play a significant role in controlling blood pressure levels. Here are some recommended changes:
Engaging in daily aerobic exercises can help in controlling your blood pressure levels. Eating a diet that’s low in salt, total fats, and cholesterol is also beneficial. It’s equally important to consume enough potassium, calcium, and magnesium in your meals.
Likewise, limiting your alcohol intake and quitting smoking is advised. It’s also essential to steer clear of unlawful drugs, such as cocaine.
Finally, if you are overweight, working towards weight loss can have a big impact on managing your hypertension.
