Recent studies have demonstrated the importance of the top number -- your systolic blood pressure. In fact, the systolic pressure may be a better indicator of your risk for heart disease and stroke than the bottom (diastolic) pressure.
The American Heart Association stresses the importance of lowering your systolic pressure -- it may even save your life!
When only the top (systolic) number is elevated, doctors call this isolated systolic hypertension (ISH). The condition becomes increasingly common as people age. A person has ISH if the top reading is higher than 140 while the bottom reading is less than 90.
The wider the spread between the systolic (top) number and the diastolic (bottom) number, the stiffer the arteries in your body -- and the greater the risk of stroke and heart disease.
In most people with ISH, the problem is either ignored or only partially treated.
When you go to the doctor, be sure to ask about both your systolic and diastolic blood pressure readings. If your blood pressure is too high, talk to your doctor about making some lifestyle changes and whether medication is neccessary.
Treatment of high blood pressure should begin early to prevent organ damage. A growing number of young people have ISH -- and both young and old benefit greatly from early treatment.
If you have ISH, here are some points to consider:
The goal for therapy is to bring the systolic number below 140.
Often, 2 or 3 medications are needed to successfully treat ISH.
In people with diabetes, blood pressure should be kept below 130/80. Having diabetes makes it more difficult to treat ISH.
In people with kidney failure or heart failure, blood pressure should be kept at the lowest level tolerated (i.e., without getting symptoms such as lightheadedness).
Blood pressure should be lowered slowly in older people with longstanding, severe systolic high blood pressure.
For some people, blood pressure goals may take longer to reach. This may be referred to as "resistant hypertension."
Review Date: June 3, 2003
Reviewed By: Jacqueline A. Hart, M.D., Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor,
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