What Is Isolated Systolic Hypertension?

Written by Carlie Olenick, Matt Smith
Medically Reviewed by Shruthi N, MD on July 21, 2025
9 min read

Isolated systolic hypertension means only your top blood pressure number is high. Your systolic blood pressure (top number) is higher than 130 but your diastolic pressure (lower number) is normal. 

Your doctor uses both numbers to measure your blood pressure:

  • The top number is called your systolic blood pressure — the force on your arteries as your heart pumps blood.
  • The bottom number is called your diastolic blood pressure — the force on your arteries when your heart is resting.

You'll likely hear your doctor or nurse say your blood pressure using both numbers. They'll tell you the systolic "over" the diastolic pressure. A standard blood pressure reading is less than 120 over 80. You probably won't know you have isolated systolic hypertension unless your doctor tells you. 

It's the most common kind of high blood pressure in people aged 70 or older. About 15 out of every 100 older people in the U.S. have isolated systolic high blood pressure. And the higher your top number, the greater your risk for heart problems.

There aren't usually any noticeable signs of isolated systolic high blood pressure until it causes serious health issues. Without treatment, it can damage your organs. That's why high blood pressure is sometimes called "the silent killer." Find out how to recognize the signs of isolated systolic hypertension and explore treatments to help you avoid complications.

As your arteries get stiffer and less flexible with age, it can get harder to pump blood out of your heart. And handling blood flow and pressure changes can be harder, too. When that happens, your systolic blood pressure (the top number) starts to go up. This is a normal part of getting older.

But your resting (diastolic) pressure might stay the same or even go down. That's how you can end up with isolated systolic hypertension — higher systolic blood pressure but normal diastolic pressure.

One big reason your arteries lose flexibility is atherosclerosis — a condition where fatty deposits and calcium build up inside your arteries. It's still unclear exactly how this happens, but over time, the buildup (plaques) can cause your artery walls to be even less elastic.

Can stress cause isolated systolic hypertension? 

Although linked, stress doesn't directly cause isolated systolic hypertension. "Stress may not be the sole cause of isolated systolic hypertension (ISH), but it's a significant contributor," says Bhavna Suri, MD, a cardiologist at Manhattan Cardiology in New York. "Especially in younger adults, who may have anxiety, sleep issues, or high-demand lifestyles."

Stress can temporarily cause your arteries to get smaller (constrict). "That's because stress can release hormones like adrenaline and cortisol, and these stress signals can also raise your systolic blood pressure," says Suri. "Chronic stress may also contribute to stiffness in your blood vessels over time."

If your systolic blood pressure gets high only when you go to the doctor, it's common. Anxiety during a medical visit can raise your systolic blood pressure temporarily. "It even has a name — white coat hypertension," says Suri. "And it can mimic isolated systolic hypertension."

High blood pressure, including isolated systolic hypertension, can slowly damage the inside of your arteries. The extra pressure can cause tiny tears in the walls of your blood vessels, where a chemical called LDL, or "bad" cholesterol, can build up inside the tears and form a layer called plaque. That makes your arteries narrower and raises your blood pressure even higher.

When that happens, the arteries carrying oxygen to your heart can get blocked, leading to complications such as: 

  • Heart attack
  • Heart failure
  • Higher blood pressure leads to heart valve problems and a thicker left ventricle
  • A stroke if the blood flow is limited or cut off to part of your brain 
  • Bursting of the blood vessels in your brain, which can cause an aneurysm or a stroke
  • Blocked blood vessels, which can block blood flow to your eyes and lead to eyesight loss
  • Damage to the arteries around your kidneys, which can keep your blood from being filtered properly and may lead to chronic kidney disease

You may have a higher risk for isolated systolic hypertension if you are:

  • Over 60 years old
  • A woman
  • Black

While isolated systolic hypertension is most common in older adults, it's starting to show up more often in people under 40, too. Certain risk factors seem to play a role, such as being a man, not having insurance, and using tobacco.

You may also have a higher risk for isolated systolic hypertension if you have: 

  • High cholesterol
  • Too much thyroid hormone (hyperthyroidism)
  • Heart valve disease
  • Diabetes
  • A BMI over 30 
  • A habit of using tobacco
  • A diet high in processed, high-fat, and salty foods

Other medical conditions that cause your heart rate to increase can also raise your risk for isolated systolic hypertension. These can include anemia, hyperthyroidism, and Paget's disease.

Blood pressure is grouped into stages. And isolated systolic hypertension fits in, too — especially when your top number (systolic) is high but your bottom number (diastolic) stays normal.

Here's a simple way to understand the stages: 

  • Normal (top number under 120, bottom number under 80): No treatment needed — just keep up healthy habits.
  • Elevated (top number 120-129, bottom number under 80): You can try lifestyle changes to lower your systolic blood pressure.
  • Stage 1 hypertension (top number 130-139 or bottom number 80-89): If you have a lower heart disease risk, you may consider lifestyle changes. But with a higher heart disease risk, you may need medications.
  • Stage 2 hypertension (top number 139 or more, or bottom number 89 or less): Both lifestyle changes and medications are needed.

If you've got isolated systolic hypertension, chances are your top number puts you in stage 1 or stage 2 hypertension, even if your bottom number looks fine. It's important to treat it early to avoid serious health problems later.

Your doctor may suggest lifestyle changes to bring your blood pressure down. They may talk to you about:

  • Salt: Try not to eat less than 2300 to 2800 milligrams of salt each day.
  • Muscle mass: As your body gets older, you lose muscle. It can help to reach your goal weight through moderate exercise and strength training.

But if these habits aren’t enough, "your doctor may check for other causes like hyperthyroidism or adrenal issues," says Suri. "They may also consider a low-dose antihypertensive medication, if your isolated systolic hypertension persists.”

Some medicines used to control isolated systolic high blood pressure (antihypertensives) include:

  • Diuretics (water pills) to help your kidneys flush water and sodium from your body
  • Calcium channel blockers to relax your blood vessels and lower your heart rate
  • Angiotensin-converting enzyme (ACE) inhibitors to relax your blood vessels
  • Angiotensin II receptor blockers (ARBs) to relax your blood vessels
  • Aldosterone antagonists (also called mineralocorticoid receptor antagonists) help your body get rid of sodium

Although we can't prevent our arteries from getting older, we can make healthier lifestyle choices. You can lower your risk for isolated systolic hypertension and protect your heart if you:

Stop smoking. There are lots of good reasons for this, but nicotine in tobacco can raise your blood pressure. Quitting is one of the best things you can do for your heart. 

Manage other health conditions. If you have high cholesterol, diabetes, or high blood sugar, staying on top of those can help prevent blood pressure problems in the future. 

Eat well. Focus on whole foods like fruits, vegetables, whole grains, and lean proteins. Try to cut back on salty snacks, fast food, and anything high in saturated fat or added sugar. 

"Try eating a DASH diet that is low in sodium, high in potassium, and rich with fruits and vegetables. Stay well hydrated and avoid extra sugar and processed foods," says Suri.

Watch your alcohol intake. If you drink, keep it moderate — no more than one drink a day for women or two for men. And avoid binge drinking. It puts extra stress on your heart.

Keep your weight in a healthy range. A BMI under 30 is considered a healthier range and linked to a lower risk for ISH. But if your BMI is higher than that, losing even a small amount of weight can make a difference.

Monitor your blood pressure. Keep track of your blood pressure at home. Use a home blood pressure monitor to log your blood pressure. Go to your follow-up visits and bring your log.

Get regular exercise. Aim for at least 150 minutes of physical activity a week. That could be walking, biking, swimming — whatever gets your heart pumping.

Get enough sleep. Adults need about seven to nine hours each night. Poor sleep can raise your risk for high blood pressure over time.

Lower your stress. Even "mindfulness, meditation, yoga, and regular physical activity (aerobic and resistance training), along with having a good sleep routine, help," says Suri. These daily habits can help keep your top blood pressure number in a healthy range. A healthy lifestyle can lower your risk for serious health issues later.

With isolated systolic hypertension, you may monitor your condition at home. Talk to your doctor about hypertensive crisis symptoms. Sometimes, you may need medical care right away. Get immediate medical care if you experience:

  • Chest pain
  • Shortness of breath
  • Dizziness or fainting
  • Headache

Isolated systolic hypertension happens when your top blood pressure number is high but your bottom number is normal. This type of high blood pressure commonly shows up without any symptoms as a normal part of getting older. But healthy habits, such as staying active, eating well, and managing your heart health, can lower your risk for high blood pressure. Talk to your doctor about lifestyle changes and treatment options to help you lower your systolic blood pressure.

Which is worse, high systolic or high diastolic?

Both numbers matter when it comes to your blood pressure. But doctors usually pay closer attention to the top number (systolic). That's because higher systolic pressure has been linked to a greater risk for heart disease and stroke — especially in people over 50.  It's a good idea to check your numbers regularly and talk with your doctor about what they mean for your health.

What is dangerously high systolic blood pressure?

A systolic (top) number of 180 or higher is considered dangerously high. It could mean you're in a hypertensive crisis. You should get emergency medical care right away, especially if you also have chest pain, shortness of breath, dizziness, or a headache. 

How to lower systolic blood pressure naturally

You can help lower your systolic (top) number by:

  • Staying active and reaching your target weight
  • Eating less salt, fat, and sugar and adding more fiber and whole grains to your diet
  • Managing your other health conditions, such as diabetes and cholesterol
  • Avoiding tobacco and alcohol

Make these healthy habits part of your daily routine for better blood pressure control and heart health.