Treatment And Management Of Isolated Systolic Hypertension In Older Adults

Isolated systolic hypertension

Isolated systolic hypertension (ISH) is defined as having a systolic blood pressure of over 140 millimetres of mercury (mm Hg) and a diastolic blood pressure of under 90 mm Hg when normal blood pressure is around 120/80 mm Hg.¹ Isolated systolic hypertension is the predominant type of hypertension in the elderly population, accounting for 70% of cases.² ISH is caused by stiffness and lack of stretch in the arteries, which happens naturally with age.

What is the difference between systolic and diastolic blood pressure?

Systolic blood pressure is regarded as the maximum pressure during heart contraction, and diastolic blood pressure is the minimum pressure before the next contraction. 

Symptoms, diagnosis, and risk factors

An individual with high blood pressure typically will not show any noticeable symptoms, however, a medically trained professional may look for signs and symptoms of another medical condition known to cause hypertension, such as: 

• Chest pain
• Blurry vision
• Nosebleeds
• Headaches
• Breathlessness

Isolated systolic hypertension is caused by a loss of elasticity (stretch) of your arteries, meaning they can no longer contract and expand as well as they used to, causing your systolic pressure to rise and diastolic pressure to fall. Risk factors in the development of ISH can include:

• High cholesterol
• Diabetes
• Obesity
• Smoking
• Eating a lot of processed and high-fat foods
• Lack of exercise

To diagnose isolated systolic hypertension, a healthcare provider will measure your blood pressure at multiple appointments and may refer you for an Electrocardiogram (EKG) and blood test to determine your likelihood of heart disease. 

How is isolated systolic hypertension treated?

Isolated systolic hypertension can be treated and managed through both medication and lifestyle changes. Your healthcare provider will discuss a treatment plan with you. Lifestyle changes may include:

• Frequent exercise
• Eating more fresh fruit and vegetables
• Losing weight
• Limiting the consumption of alcohol, fatty and salty foods
• Quitting smoking
• Stress management

Some symptoms of hypertension may be treatable by lifestyle changes, your doctor may also prescribe you medication to restore the elasticity of your arteries and lower your blood pressure. These medications are called antihypertensives. Some examples include:

• Diuretics
• Angiotensin-converting enzyme inhibitors (ACE inhibitors)
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers (CCBs)

Your doctor may prescribe you one or multiple of these medications, depending on how well your body responds to treatment.

How do antihypertensives work and do they have side effects?

Diuretics 

The most common antihypertensive prescribed is a thiazide diuretic, typically a go-to first medication for older patients. A low dose will be prescribed and may be paired with another drug. Side effect of thiazide diuretics is hypokalemia (low potassium), which can be treated by a simple diet change. 

ACE Inhibitors 

These drugs are more commonly used to treat people with heart failure or those with type 2 diabetes or chronic kidney disease. They help to lower blood pressure by inhibiting the enzyme responsible for the production of Angiotensin II, a hormone that causes blood vessels to tighten. Side effects of this drug may include a dry cough, dizziness, and fainting. 

ARBs 

These drugs reduce the effect of the hormone angiotensin II and prevent it from causing the blood vessels to tighten. ARBs work by blocking the receptors that the hormone binds to. Side effects may include headaches, dizziness, and fatigue, but these symptoms usually last a few days.⁵ 

CCBs 

These drugs prevent calcium from entering the heart and arteries weakening its contraction, allowing them to stretch, relax, and lower blood pressure. CCBs are often prescribed along with diuretics. Side effects may include headaches, lightheadedness, and leg swelling.

Why is treatment important?

Treatment of isolated systolic hypertension is crucial in reducing mortality and lowering the risk of developing cardiovascular diseases or stroke. A target systolic blood pressure of under 140 mm Hg is recommended.³ The prognosis for ISH is generally favourable in patients who receive treatment and make appropriate lifestyle changes.

Monitoring isolated systolic hypertension 

A recommended method of managing ISH is daily monitoring of ambulatory blood pressure. This involves tracking your blood pressure throughout the day as you go about your normal activities. A digital blood pressure monitor is connected to a belt worn around your waist and attached to a cuff on your arm. As blood pressure fluctuates throughout the day due to activity, stress, or metabolic needs, an ambulatory blood pressure monitor provides a more accurate physiological picture of the patient's “real” blood pressure.⁴

FAQs

When should I see a doctor?

The symptoms of high blood pressure as a result of isolated systolic hypertension often go undetected. You should visit your healthcare provider or use an at-home blood pressure monitor if you are:

• A smoker
• Overweight or obese
• Pregnant
• Have a family history of high blood pressure

If you decide to monitor your blood pressure at home, log your findings and take them to show your healthcare provider. You must visit a doctor or healthcare provider if you think you may be suffering from ISH. 

Can ISH be cured?

No, but it can be managed by medication and lifestyle changes. Your doctor will prescribe you one or more types of antihypertensive medication to lower your blood pressure, this medication will typically be taken for the rest of your life, however, in some circumstances, lifestyle changes may lower your blood pressure to a suitable level where medication is no longer necessary, or a lower dosage is possible.

Summary

Isolated systolic hypertension (ISH) is the most common form of hypertension found in the elderly population, making up 70% of total cases. ISH is caused by the arteries becoming stiff and unable to stretch efficiently due to old age. ISH is diagnosed by recurring high blood pressure shown as 140/90 mm Hg against the normal range of 120/80 mm Hg.

People who are overweight or obese, smokers, have diabetes, live a sedentary lifestyle, or consume a diet high in processed foods are at higher risk of developing ISH. Diagnosis is carried out by multiple doctor visits where they will test your blood pressure, alternatively, you can measure your blood pressure frequently at home and take the results to your doctor.

When diagnosed, your doctor or healthcare provider will prescribe you medications called an antihypertensive, which will help to stretch and relax your arteries, allowing your blood pressure to lower. Lifestyle changes are recommended alongside medication and can even play a part in reducing your dosage. Common lifestyle changes include increased exercise, eating more fresh fruits and vegetables, and quitting smoking.

Early diagnosis is key to achieving a good prognosis and reducing your risk of further complications like heart disease. If you have a family history of high blood pressure, are pregnant, or are overweight or obese, you should schedule an appointment with your healthcare provider to get your blood pressure measured.