Overview

Do you know when your doctor says your BP is 120/80mmHg? What does he actually mean? Well, let me explain. Your doctor is telling you the force on your arteries when your heart pumps blood and the force on the arteries when your heart rests.

When your heart pumps blood, the force on your arteries is known as the systolic blood pressure, and this is represented by the first number, which measures 120mmHg. 

The 80mmHg represents the diastolic blood pressure, which is the force on your arteries when your heart is resting.T he systolic blood pressure is always expressed first, followed by the diastolic blood pressure.

Hypertension 

When your diastolic blood pressure exceeds 90 mmHg and your systolic blood pressure exceeds 140 mmHg, indicates high blood pressure, often known as hypertension.

Isolated systolic hypertension

Isolated systolic hypertension is the term used to describe the situation when diastolic blood pressure is normal (less than 90 mmHg), but your systolic blood pressure is more than 140 mmHg.¹

Isolated systolic hypertension is more common in older adults and can increase the risk of heart disease and stroke. Treatment for isolated systolic hypertension may include lifestyle changes, such as exercise and a healthy diet, as well as medication if necessary.

Symptoms of isolated systolic hypertension individuals with isolated systolic hypertension do not typically exhibit symptoms. If left untreated for a prolonged period, hypertension can cause significant damage to your organs, resulting in various health complications² such as:

• Chest pain
• Breathlessness
• Headaches
• Blurred vision

Causes of isolated systolic hypertension

High blood pressure can have a detrimental impact on the interior of the arteries over time, leading to the formation of micro-tears in the walls. In the case of damaged blood vessels, a substance known as LDL cholesterol can accumulate and form a plaque. As a result, the arteries become narrower, leading to an increase in blood pressure.

This can result in blockage of the arteries supplying oxygen to the heart which can cause a heart attack or stroke. It may also cause the brain's blood vessels to burst, which can result in a stroke. In other areas of the body, it might damage the arteries around the kidneys, preventing them from properly filtering the blood or strain the blood vessels in the eyes, causing them to lose vision.

Some conditions can make you more susceptible to developing isolated systolic hypertension.³ The presence of these conditions in your body can negatively impact your circulatory system, leading to possible damage to your blood vessels or even contributing to the stiffening of your arteries.³

• Anaemia
• Diabetes 
• Hyperthyroidism
• Obstructive sleep apnoea
• Aortic insufficiency 
• Paget's disease
• Beriberi 

Diagnosis of isolated systolic hypertension

One of the main obstacles to diagnosis is that high blood pressure usually exhibits no symptoms or warning indications. Monitoring it is the only way to determine whether it is too high. When it comes to getting your blood pressure measured, you have a few alternatives. It is measurable:

• At home with a home blood pressure monitor, 
• In your doctor's office, 
• During a health examination at a drugstore with a digital blood pressure measuring machine

Before determining if you have isolated systolic hypertension, your doctor will take your blood pressure in two or three sessions. To determine your risk of cardiovascular (heart and blood vessel) disorders, they might wish to do further tests, like:

• an ECG, or electrocardiogram
• Blood tests to measure your cholesterol levels, such as a lipid panel

Treatment for isolated systolic hypertension

As with other types of hypertension, isolated systolic hypertension (ISH) may be managed. Your systolic blood pressure should drop to less than 140 mmHg. Medication, alterations in lifestyle, or a combination of the two can do this.

A balanced therapy approach is crucial to lower systolic blood pressure without unduly lowering diastolic blood pressure. Heart damage may result from diastolic blood pressure that is lower than usual.⁴

Your doctor will also attempt to treat any underlying conditions that may be causing or exacerbating your ISH symptoms.

The treatment involves medications, but an equally important part is the changes you make to your daily routine. The doctor would recommend some lifestyle changes that may make an equal impact as that of medications in controlling isolated systolic hypertension.

Role of diet in managing isolated systolic hypertension

Diet plays an integral part in managing Isolated systolic hypertension. By making minor changes to your diet, you may lower your blood pressure and the number of medicines you take. These small changes may be:

• Keeping a record of what you are eating
• Reducing salt intake
• Increasing fibre in your diet
• Adopting a DASH diet

Keeping a record of what you are eating

Keeping a record of what you eat throughout the day gives you insight into how much you eat. This way, you can easily control your diet by avoiding unhealthy snacking.

Reduce salt intake

The recommended daily dose of sodium salt is 6g/day, equal to around one level teaspoon. ⁵ This one teaspoon of sodium salt includes everything we eat and drink all day. Consuming too much salt over a long period can cause hypertension, which constricts and tightens the blood vessels. The decrease in blood and oxygen flow negatively impacts vital organs. Consequently, the heart works harder to ensure proper blood circulation, thereby increasing blood pressure.

The kidneys' filtering units can develop scarring due to the additional pressure exerted by hypertension. The impairment of the kidney's ability to regulate fluid leads to an increase in blood pressure.

Increase fibre in your diet

Increasing fibre in your diet can reduce the risk of cardiovascular diseases by 15-30%.⁶

The primary mechanism behind the correlation between high fibre intake and cardiovascular diseases lies in the extensive fermentation of fibre by the gut microbiota. As a result of this fermentation process, short-chain fatty acids are released, which play a crucial role in promoting vasodilation and its positive impact on cardiovascular health.⁶

The primary sources of fibre are fruits and vegetables, legumes, nuts, lean meat, and poultry.

Adopting a DASH diet

The DASH diet (Dietary Approaches to Stop Hypertension) 

is one that is high in fruits, vegetables, whole grains, fish, poultry, legumes, nuts, and low-fat dairy products. The diet also contains essential minerals, including potassium, magnesium, calcium, fibre, and protein. 

The diet was formulated after researchers observed that individuals who followed a plant-based diet, like vegans and vegetarians, had a notably lower incidence of high blood pressure. ⁷

The DASH diet includes certain lean protein sources, including chicken, fish, and beans. Red meat, salt, added sugars, and fat are minimal.

As with most national standards, the conventional DASH diet programme recommends no more than one teaspoon (2,300 mg) of salt daily.

Role of exercise in managing isolated systolic hypertension

Engaging in physical activity helps decrease blood pressure and improves heart health, weight management, and stress reduction. A robust heart, a healthy weight and overall mental well-being benefit blood pressure levels.

Heart health improves with regular exercise. A robust heart can pump more blood with less effort, reducing the force on the arteries and lowering blood pressure.

Regular exercise regulates blood pressure. It takes one to three months for regular exercise to start showing results. It is crucial to remember that the advantages are only permanent if you keep up your fitness regimen. It has been demonstrated that the most significant advantages for heart health come from a combination of aerobic and strength training activities.

It is recommended to perform muscle-strengthening activities two to three days a week for at least 30 minutes⁸ of cardiovascular activity, such as brisk walking, cycling, swimming, etc., five days a week. Resistance training such as pushups, planks, squats and other exercises or weight cuffs, resistance bands, dumbbells, etc., are examples of exercises that will increase our muscular strength.

Exercise tips for isolated systolic hypertensive patients

Before starting exercise, it is advisable to get advice from your doctor. Start slow but steady.

Start with low-intensity exercises, stick to your routine and find an exercise partner. The following exercises are usually advised for hypertensive patients.

Aerobic exercises

Cardiovascular exercise, or aerobic exercise, can help decrease blood pressure and strengthen the heart. Walking, running, jumping rope, stationary or outdoor cycling, cross-country skiing, skating, rowing, swimming, water aerobics, high—or low-impact aerobics, and skating are a few examples.

Strength training

Strength training increases your daily calorie expenditure by strengthening your muscles. It also benefits your bones and joints.

Stretching

Stretching improves your range of motion, increases flexibility, and helps you stay injury-free.

Summary

Isolated systolic hypertension (ISH) is characterised by elevated systolic blood pressure (SBP), while diastolic blood pressure (DBP) remains normal. It is common in older adults and increases the risk of heart disease and stroke.

Lifestyle changes, including diet and exercise, are critical components of managing ISH alongside medication if necessary. Dietary modifications such as reducing sodium intake, increasing fibre consumption and adopting the DASH diet can help lower blood pressure. 

Regular physical activity, including aerobic and strength training exercises, improves heart health and helps control blood pressure. Combining these lifestyle changes with medication can effectively manage ISH and reduce the risk of associated complications.