Blood pressure is one of the most essential risk factors for health problems such as heart disease, stroke, kidney failure, and early death. Over time, uncontrolled high blood pressure damages the delicate tissues inside arteries and causes dangerous plaque buildup. Monitoring and proper blood pressure management is essential to protecting long-term health.
Though the focus has long been largely on diastolic pressure, research shows that systolic might be far more important for blood pressure management. Read on to explore the reasons.
Understanding Key Blood Pressure Terms
Blood pressure measures the force exerted on artery walls as blood pumps from the heart to tissues throughout the body. It’s recorded as two numbers, systolic pressure over diastolic pressure, which correspond to peak and minimum pressures with each heartbeat.
Systolic pressure represents the maximum force against arteries that occurs when the heart contracts to pump blood out. Diastolic pressure is the minimum force on arteries in between heartbeats as the heart relaxes and refills with blood.
Normal blood pressure for adults is defined as below 120 mmHg systolic as well as below 80 mmHg diastolic. Levels above this range are classified as:
- Elevated: Ranging from 120 to 129 systolic as well as less than 80 diastolic
- Stage 1 hypertension: Ranging from 130 to 139 systolic or 80 to 89 diastolic
- Stage 2 hypertension: A minimum of 140 systolic or a minimum of 90 diastolic
The systolic number comes first because it gives the greatest indication of cardiovascular disease risk.
Isolated Systolic Hypertension: An Age-Related Pattern
Many people develop a condition called isolated systolic hypertension (ISH) as they get older. ISH is defined as systolic pressure of 130 mmHg or higher with normal diastolic pressure (less than 80 mmHg).
After age 50, stiffening and loss of elasticity in major arteries cause systolic pressure to rise. However, diastolic pressure starts to fall due to a higher level of resistance in smaller vessels. So, systolic pressure creeps higher while diastolic stays the same or drops.
By age 65, over 65% of hypertensive adults have ISH with disproportionately elevated systolic compared to diastolic pressure. This makes systolic blood pressure the most significant contributor to cardiovascular risk in mature adults.
Linking Systolic Pressure to Cardiovascular Risks
Many studies clearly demonstrate that higher systolic blood pressure strongly predicts a higher incidence of:
- Coronary heart disease
- Stroke
- Peripheral artery disease
- Atrial fibrillation
- Heart failure
- End-stage renal disease
In an analysis of over 316,000 adults, the risk for cardiovascular events increased progressively for each 20 mmHg rise in systolic pressure. Conversely, while diastolic pressure also had an effect on risk, it wasn’t quite as pronounced.
Additionally, in the Framingham Heart Study, deaths from heart disease and stroke climbed steadily and linearly with rising baseline systolic blood pressure levels.
Importantly, at any given systolic level, having higher diastolic pressure seems to lower the risk for heart disease somewhat. This suggests widening pulse pressure (the gap between systolic and diastolic values) may indicate worsening arterial stiffness.
Regardless, across all ages, risk prediction models and treatment guidelines consistently point to elevated systolic pressure as the strongest modifiable predictor of cardiovascular disease.
Systolic Pressure Is More Challenging to Control
With ISH in seniors and prehypertension in younger adults often manifesting first through systolic pressure elevation, controlling systolic blood pressure is essential. However, studies repeatedly show that systolic pressure is more difficult to reduce and maintain below target levels.
For example, the Third National Health and Nutrition Examination Survey (NHANES) found that 83% had diastolic pressure controlled to less than 90 mmHg, but only 32.7% met the systolic target of less than 140 mmHg.
Difficulty controlling systolic pressure worsens with age. Key reasons include:
- Longer duration of uncontrolled hypertension causing more arterial stiffness
- Higher baseline systolic levels before treatment begins
- Concerns over lowering diastolic pressure too far in older patients
- Reluctance to intensify medication regimens in older adults
Because systolic pressure conveys the greatest cardiovascular risk, lack of systolic control translates to far more heart attacks, strokes, and deaths at a population level.
Aggressive Reduction of Systolic Pressure Saves Lives
The good news is that actively treating elevated systolic blood pressure to target goals significantly lowers cardiovascular events.
The original Systolic Hypertension in the Elderly Program (SHEP) conclusively proved that reducing systolic blood pressure by just 10-12 mmHg in older adults with ISH decreased:
- Heart failure by around 49%
- Stroke by approximately 36%
- Major cardiovascular events by around 32%
The SPRINT trial next showed that aiming for a very low systolic goal of under 120 mmHg instead of the usual 140 mmHg cut rates of:
- Heart failure by 38%
- Death from any cause by 27%
Heart attacks and strokes also declined significantly, but no precise percentages were provided. This proves that even small reductions in systolic pressure translate into enormous risk reduction — especially in higher-risk adults.
Aggressively monitoring systolic pressure and intensifying treatment accordingly remains one of the most effective strategies doctors have for preventing debilitating complications of hypertension.
Control Your Blood Pressure Starting Today with Imperial Center Family Medicine
Raised blood pressure rarely causes noticeable symptoms. The best way to understand systolic pressure levels and overall heart disease risk is through regular screenings.
Imperial Center Family Medicine specializes in blood pressure management as well as cardiovascular health in the Durham, NC Tristate area. Our expert healthcare providers offer blood pressure testing, education, and expert guidance on lifestyle changes and medication options to help patients gain control.
Our team closely tracks systolic and diastolic numbers with the goal of not just general control but optimal reduction customized to every patient’s needs. Contact us today at 919-873-4437 or online to make an appointment to discuss your heart health.