A blood pressure problem that’s isolated in name only

How to deal with isolated systolic hypertension.

Stiff joints are an outward sign of aging. They're a pain, literally, and can slow you down or keep you from doing the things you want to do.

Stiff arteries are equally problematic. They are the main culprit behind the gradual rise in blood pressure with age.

You can't feel high blood pressure, but it can stop you just as surely as stiff joints can, and sometimes more permanently.

A blood pressure reading contains two numbers. The top number is the systolic pressure. It gauges the pressure in the arteries when the heart contracts and pushes a wave of blood along the arterial tree.

The bottom number is the diastolic pressure. It reflects the pressure during the lull between waves, as the heart relaxes in between beats.

It takes a fair amount of pressure to push blood through miles of arteries. Too much pressure, though, is a bad thing.

It injures cells lining the inside of arteries. It also makes them vulnerable to the microscopic changes that lead to atherosclerosis.

In other words, high blood pressure sets the stage for cardiovascular catastrophes like heart attack and stroke.

We usually think of systolic and diastolic pressure rising in tandem, but that isn't necessarily the case. In fact, by age 60, most people with high blood pressure have what's called isolated systolic hypertension - a systolic blood pressure above 140 with a normal (under 90) diastolic pressure.

Some experts don't like the name isolated systolic hypertension. They worry that the word "isolated" sends a message that this condition isn't much of a problem. But it is.

Every 20-point increase in systolic blood pressure (and every 10-point increase in diastolic) doubles the chances of having a stroke.

This hazard is seen even among people with mildly elevated blood pressure, what is now being called prehypertension.

In fact, a study published online in the medical journal BMJ suggests that heart attacks, strokes, and deaths from cardiovascular disease are twice as common among women with what used to be called high normal blood pressure (a systolic pressure between 130 and 139 and/or a diastolic pressure between 85 and 89) as among those with normal blood pressure.

A variety of medical conditions can lead to, or contribute to, systolic hypertension.

These include anemia, an overactive thyroid or adrenal gland, a malfunctioning aortic valve, kidney disease, and even obstructive sleep apnea. Most of the time, though, it stems from the gradual stiffening of large arteries.

This occurs for many reasons. A key cause is the development of cholesterol-filled patches in artery walls, part of the artery-clogging process known as atherosclerosis.

Atherosclerosis is exacerbated by smoking, inactivity, and high blood pressure itself.

If the top number of your blood pressure reading is above 140 and the bottom number is under 90, you have isolated systolic hypertension.

Your doctor should run tests to rule out anemia and the other medical conditions that can cause isolated systolic hypertension.

He or she should also evaluate your cardiac risk factors (weight, cholesterol, etc.) and see if you are showing any signs of hypertension-related damage to the eyes and kidneys.

Then it's time to do battle with blood pressure. It isn't an entirely straightforward process.

That's reflected in the fact that only about one-third of people diagnosed with high blood pressure have it under control.

The best place to start is with the choices you make in your daily life. Smoking, carrying too many pounds, eating too much salt, drinking an excess of alcohol, not exercising - all contribute to high blood pressure.

By trading these in for their healthier alternatives, you can watch your blood pressure drift downward. Diets that emphasize fruits, vegetables, lean protein, and whole grains also help lower blood pressure.

Don't be too quick to skip the lifestyle changes and head straight for medicines that lower blood pressure. While drug therapy targets blood pressure, the benefits of positive lifestyle changes reverberate throughout the body.

They don't just improve your heart and arteries, but are also good for your lungs, muscles, bones, brain, and parts in between.

If lifestyle changes aren't enough to get your blood pressure under control, the best type of drug therapy depends on your starting systolic blood pressure.

If it is between 140 and 159 (called stage 1 hypertension), guidelines suggest starting with a thiazide diuretic (water pill) such as chlorothiazide (Aldoclor, Diupres, Diuril), chlorthalidone (Hygroton), or hydrochlorothiazide (Esidrix, HydroDiuril, Microzide).