Blood Pressure, Hypertension and Systolic Hypertension

Q:  I'm a little confused about the diagnosis of hypertension. I've heard of something called "isolated systolic hypertension" and would like some clarification on what it means and how or if it should be treated.

A:  High blood pressure or hypertension (HTN) is the most common cardiovascular disease and one of the greatest public health problems of our time, affecting more than 60 million Americans. It directly contributes to the deaths of at least 250,000 people per year in the United States.

Blood pressure measurements typically contain two numbers. The higher is called systolic blood pressure and represents the pressure in the arterial system caused by the heart as blood is being pumped out. The lower number is called the diastolic pressure and represents the portion of time when the heart muscle is resting and filling with blood.

Optimal blood pressure is 120/80 or less. Borderline systolic blood pressure is 130-139 with high systolic blood pressure defined as 140 or higher. Borderline diastolic pressure is defined as 85-89, with high diastolic blood pressure beginning at 90 and higher. Most people with HTN have elevations in both numbers, although the diagnosis can be made if either reading is elevated, as one would see in isolated systolic hypertension.

Untreated or poorly treated HTN can cause stroke, heart attacks, kidney failure and severe circulation problems. Keep in mind that in most people HTN occurs without any symptoms whatsoever. There is thus far no identifiable cause for HTN in most people. They are classified as having "essential" HTN. About 5% of people have a cause for their elevated blood pressure such as pre-existing kidney disease that can be reversed and places them in the category of "secondary" HTN.

Everyone -- including children -- should have their blood pressure measured every time they see a doctor. Special attention should be paid when there is a family history of HTN requiring at least annual measurements beginning at age 20.

Treatment for many people with HTN may involve weight loss, dietary modifications and exercise as a first attempt and an effort to avoid medications. If medications are needed, most doctors being with the lowest dose possible and try to select the drugs with the fewest side effects.

This is an area where a little difference in the care of one's health can have tremendous positive consequences. Think of your future not in the number of years you are going to live, but how you want to live them, and the events you hope to see such as weddings, graduations, grandchildren.

"Your Health" provides easy-to-understand information about common health conditions.