In a blood pressure reading, is having a high top number but an OK bottom number cause for concern?
Answer From Francisco Lopez-Jimenez, M.D.
Yes. If your top blood pressure number is high and your bottom number is within a healthy range, talk with your healthcare professional. You may have a type of high blood pressure called isolated systolic hypertension. But it takes more than one blood pressure test to confirm the condition.
In a blood pressure reading, the top number is called systolic blood pressure. The bottom number is called diastolic blood pressure. Both numbers are measured in millimeters of mercury (mm Hg). In general, a blood pressure reading of 120/80 mm Hg or lower is ideal.
Isolated systolic hypertension happens when the top blood pressure number is 130 mm Hg or higher and the bottom number is less than 80 mm Hg. Isolated systolic hypertension is the most common type of high blood pressure, especially in older age.
Isolated systolic hypertension can be caused by conditions such as:
- Artery stiffness.
- An overactive thyroid, also called hyperthyroidism.
- Diabetes.
- Heart valve disease.
- Obesity.
Over time, having a top blood pressure number that is high can raise the risk of stroke, heart disease, dementia and chronic kidney disease.
For adults with high blood pressure, a target blood pressure under 130/80 mm Hg is recommended for those younger than 65. For those 65 and older, American Heart Association guidelines say the top blood pressure number also should be under 130 mm Hg. But the guidelines don't specify a goal for the bottom number. Ask your healthcare team what blood pressure goal is best for you.
Blood pressure medicine can help control isolated systolic hypertension and lower the risk of related health conditions. But it's important that the treatment to lower your top blood pressure number doesn't cause your bottom number to drop too low. That can cause other complications.
If you have isolated systolic hypertension, see your healthcare team for all follow-up appointments. That way, the care team can make sure that your treatment and lifestyle changes are helping control your blood pressure.
Along with medicine, other changes also can help improve the top blood pressure number and boost heart health. Important changes include:
- Eat a healthy diet. This includes plenty of fruits, vegetables, lean protein and whole grains. Limit food that is high in sugar, sodium and saturated fat.
If you drink alcohol, do so in moderation. That means no more than one drink a day for women and two drinks a day for men. Also be aware that it's risky to binge drink even once in a while. Binge drinking means having five drinks for men or four drinks for women in two hours. Binge drinking can raise the risk of an irregular and often very fast heart rhythm called atrial fibrillation.
If you have high blood pressure, your healthcare professional may recommend not drinking any alcohol at all.
- Lose extra weight. Reaching and staying at a healthy weight has many benefits. Ask your healthcare professional to set a goal weight that's right for you.
- Get active. Work up to at least 150 minutes of physical activity a week. Or aim to get at least 75 minutes of vigorous activity a week.
- If you smoke or vape tobacco, quit. You can ask your healthcare professional for help.
- Get enough sleep. Adults should aim to get 7 to 9 hours of sleep each night.
- Manage cholesterol. High levels of LDL cholesterol, the "bad" cholesterol, raise the risk of heart disease. Work with your healthcare professional to make sure your cholesterol stays within a healthy range.
- Control blood sugar. High blood sugar can harm the heart and other organs over time. If your blood sugar is high, work with your healthcare professional to bring it into a healthy range.
With
Francisco Lopez-Jimenez, M.D.
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