For example, 120/80 mm Hg. The top number refers to the amount of pressure in your arteries during the contraction of your heart muscle. This is called high systolic blood pressure. The bottom number refers to your blood pressure when your heart muscle is between beats. This is called diastolic pressure.
Elevation of systolic vital sign predicts the danger of disorder better than increases in diastolic vital sign.
Although this was observed quite three decades ago, no attempt was made to translate this evidence into practice until in 1993, when a report of the fifth joint national committee of us for the detection, evaluation, and treatment of high vital sign recognized isolated systolic hypertension as a crucial target for the control of vital sign.
Nevertheless, it’s the elevation in a systolic vital sign that also limits our ability to regulate vital signs to the recommended goal of but 140/90 Hg.
Although related to more variability in measurement, a systolic vital sign is simpler to work out and allows more appropriate risk stratification than diastolic vital signs. In a recent analysis of the Framingham heart study, knowing only the systolic vital sign correctly classified the stage of vital sign in 99% of adults over age 60 whereas knowing the diastolic blood pressure allowed only 66% to be classified correctly.
Isolated systolic hypertension is defined as high systolic blood pressure more than or equal to 140 mm Hg and diastolic blood pressure less than 90 mm Hg and is the most common form of hypertension.4 Its prevalence increases with age occurring in two-thirds of people 65 years of age and three-quarters of those over 75 years of age.
In people aged up to 50, both diastolic blood pressure and high systolic blood pressure are independently associated with cardiovascular risk. At age 50 systolic pressure is far more important than the level of diastolic blood pressure in predicting the risk of coronary heart disease, left ventricular hypertrophy, congestive heart failure, renal failure, and mortality in people with hypertension.
At age 60 years, however, as vascular compliance is reduced, increasing systolic blood pressure and a lower diastolic blood pressure increase cardiovascular risk.
Age related physiological changes explain the frequent development of isolated systolic hypertension in older people. Younger people have a highly distensible aorta, which expands during systole and minimizes any subsequent rise in vital signs.
During Systole and Minimizes Any Subsequent Rise in Vital Sign
Most older people, however, develop progressive stiffening of their arterial tree as they age, which leads to a continuous elevation in systolic blood pressure. With the diastolic blood pressure remaining normal or decreasing with age, elderly people develop a widening of their pulse pressure (the difference between the systolic and therefore the diastolic blood pressure).
The elevation in systolic pressure increases left ventricular work and the risk of left ventricular hypertrophy, whereas the decrease in diastolic blood pressure may compromise coronary blood flow.
This widening of the pulse pressure at specified levels of systolic pressure, as assessed in the Framingham heart study, is associated with an increased risk of developing coronary heart disease.
In the absence of trial-based evidence that uses pulse pressure narrowing as a target for improving outcome, however, lowering systolic pressure to a specific goal continues to be recommended as the major criterion for the management of hypertension, especially among middle-aged and older people.
Is the Benefits of Treating Systolic Pressure?
The benefits of treating systolic blood pressure have been well documented. Trials have shown significant reductions in stroke, coronary vascular disease, heart failure, and mortality when treating patients with isolated systolic hypertension (systolic blood pressure more than 150 or 160 mm Hg, diastolic blood pressure less than 90 mm Hg).9,10
When systolic blood pressure was reduced by at least 20 mm Hg and to less than 160 mm Hg or less than 150 mm Hg, a 35-40 % reduction in stroke, a 50% reduction in heart failure, a 16% reduction in coronary events, and a 10-15% reduction in mortality occurred.9,10
The benefits of treating stage 1 isolated systolic hypertension (140 mm Hg or greater with diastolic blood pressure below 90 mm Hg) have not yet been shown in a clinical trial. Although none of the clinical trials achieved a systolic vital sign below 140 Hg.
A consensus statement implies that the outcome should improve further when this goal is achieved.
Systolic pressure remains more difficult to control than diastolic blood pressure.3 Nevertheless, doctors should be able to lower systolic pressure to less than 140 mm Hg in about 60% of patients.
A diuretic and a dihydropyridine calcium antagonist are the sole classes of medicine that are tested as initial treatment in placebo-controlled trials on isolated systolic hypertension. If a diuretic is used, potassium concentrations should be kept as close as possible to normal.
Expecting the Diastolic Blood Pressure
If not used initially, a thiamine diuretic should be included in most regimens to enhance the efficacy of other blood pressure-lowering agents and reduce the risk of ischaemic stroke.w1
Since two or more agents are often necessary to reach the target of 140 mm Hg, caution should be exercised when lowering diastolic blood pressure to less than 55 mm Hg.w2
Lifestyle changes are also beneficial in controlling blood pressure in elderly patients. Restricting salt intake to 80 mmol daily reduces systolic blood pressure by 4.3 mm Hg and diastolic blood pressure by 2 mm Hg, and a combination of weight loss and salt restriction reduces blood pressure more than either strategy by itself and decreases the need for antihypertensive treatment.w3
Isolated systolic hypertension remains the most common form of hypertension and the most difficult to treat.w4 Substantial evidence supports the value of treating isolated systolic hypertension, and we must better inform doctors and the public about its consequences.
It seems appropriate that we continually focus our efforts on more effective control of systolic blood pressure.
The Pressure Exerted by Your Blood Flowing
The pressure exerted by your blood flowing through your arteries isn’t constant but is dynamic, and constantly reflects what the guts are doing at a given moment.
When the guts are actively beating (an event called “systole”), it’s ejecting blood out into the arteries. This dynamic ejection of blood into the arteries causes the pressure within the arteries to rise.
The peak vital sign reached during active cardiac contraction is named the systolic vital sign. A “normal” systolic pressure when a person is sitting quietly is 120 mmHg or below.1
High Systolic Blood Pressure Reviews
When a person is exercising, during periods of emotional stress, or at any other time when the heart is stimulated to beat more strongly than at rest, the force of cardiac contraction increases — and the systolic pressure goes up.2
The increase in systolic pressure that occurs during these conditions of cardiac stress is entirely normal. This explains why it is so important to measure blood pressure during periods of quiet rest before diagnosing hypertension.
If the systolic blood pressure is lower than normal, systolic hypotension is said to be present. If systolic hypotension is severe enough, it can cause lightheadedness, dizziness, syncope, or (if it lasts long enough), organ failure.
Systolic hypotension can occur if the blood volume becomes too low (as with severe dehydration or a major bleeding episode), if the heart muscle becomes too weak to eject the blood normally (a condition known as cardiomyopathy), or if the blood vessels become too dilated (as in vasovagal syncope).
A common condition that produces systolic hypotension is orthostatic hypotension.3