Blood pressure is measured with a blood pressure cuff and recorded as two numbers that represent systolic (peak pressure, shown first) and diastolic (base pressure, shown second). Either or both numbers can be elevated. When the first number is the only one elevated the condition is called Isolated Systolic Hypertension (ISH). Optimal blood pressure is below 120/80mm Hg. When a person has a reading above 140/90, she/he is considered to have high blood pressure. In the past, many physicians relied on diastolic blood pressure to diagnose hypertension. Recent research, however, has found that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.

Systolic hypertension is a major health threat, especially for older people. For many years we have been taught that diastolic (the bottom number) blood pressure counts more. That may be true for younger people but we now know that, as people get older, systolic blood pressure becomes more important. If you are middle aged or older, systolic blood pressure is a better blood pressure indicator than diastolic of your risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans. High blood pressures can lead to other conditions, such as congestive heart failure, kidney damage, dementia and blindness. While it cannot be cured, systolic hypertension can be treated and its complications prevented.

Many older Americans suffer from ISH, defined as a systolic reading at or above 140mm Hg and diastolic reading under 90mm Hg. In fact, for older Americans, ISH is the most common form of high blood pressure: 65% of all hypertensives older than age 60 have ISH. Unfortunately, many older Americans do not have their blood pressure under control.

Peaks of fluctuating hypertension can be as strong a risk factor for cardiovascular disease as established hypertension.

To find out if you have ISH - or any type of high blood pressure - see your doctor and have your blood pressure checked regularly. Everyone - including children - should have their blood pressure measured every time they see a doctor. Special attention should be paid when there is a family history of hypertension requiring at least annual measurements beginning at age 20.

Untreated or poorly treated hypertension can cause stroke, heart attacks, kidney failure and severe circulatory problems. In most people hypertension occurs without any symptoms whatsoever and there is thus far no identifiable cause for hypertension in most people. They are classified as having "essential" hypertension. About 5% of people have a cause for their elevated blood pressure (such as pre-existing kidney disease) that can be reversed and this places them in the category of "secondary" hypertension.

Recent work possibly explains the cause of 30-40% of essential hypertension. Parathyroid Hypertensive Factor (PHF) is a hormone produced by the parathyroid gland. When elevated, it can cause any increase in blood pressure. PHF levels can be tested, and elevated levels could serve to predict salt sensitivity, and calcium treatment responsiveness. Meridian Valley Laboratory in Seattle, Washington is one lab that performs this test.

Treatment options for ISH are the same as for other types of high blood pressure, in which both systolic and diastolic pressures are high. The key for the treatment of ISH is to bring the blood pressure under control, to less than 140/90.

Diastolic Hypertension is when the lower number is sustained at pressures greater than 90mm Hg. Hypertension, otherwise known as chronic high blood pressure, can be treated in a number of natural ways.

Dietary salt (NaCl) restriction, dietary potassium supplementation, weight reduction, physical exercise, selected nutrients, meditation and other therapies (e.g., biofeedback) have all been found to be effective.

You should try to achieve normal pressure by a lifestyle and diet change, such as weight loss, reducing salt intake, exercising and supplementation as a first attempt in an effort to avoid medications. No one, however, has to put his or her health at risk from uncontrolled hypertension; but treatment for hypertension must begin early to prevent organ damage - whatever the patient's age.

Pulse Pressure
Although current guidelines for the management of high blood pressure (BP) rest almost completely on the measurement of systolic (top) and diastolic (bottom) blood pressure, a new study has found that something known as the "pulse pressure" may actually be a better predictor of heart disease risk. The pulse pressure is the difference between the systolic and diastolic pressures. For example someone with a blood pressure of 120/80 has a pulse pressure of 40.

This study was a meta-analysis combining the results of several studies, including nearly 8,000 elderly patients.
A 10mm Hg increase in pulse pressure was found to increase the risk of major cardiovascular complications and mortality by nearly 20%. The authors contend that this association of pulse pressure to risk of heart disease helps to explain the apparent elevations in risk associated with low diastolic pressure. The authors of the study note that some high blood pressure medications may actually increase the pulse pressure. For example, if someone has an elevated BP of 150/95 (pulse pressure = 55) and medication brings it down to 140/80 (pulse pressure = 60), then according to this study's findings, this person may actually be at GREATER risk of heart disease than before.

Researchers found that a diuretic, or water pill, is more effective in treating high blood pressure and preventing cardiovascular disease than newer, more expensive medications. It was 10 to 20 times less expensive than the other drugs used in the trial. The eight-year study, led by a doctor at Wake Forest University Baptist Medical Center, included 623 clinical sites in North America. There should be less side effects also.