High Systolic Blood Pressure: Causes and Risk Factors

“What we do over the course of our lives,” Singh summarizes, can abate the risk of hypertension even from things we can’t modify, like our genes; or it can increase our risk.

Research suggests the way genes interact with our environment — which includes behavior patterns such as lifestyle choices — also contributes to blood pressure. As with genetics, the effect of age on blood pressure is also more variable than it may seem at first. It’s not as simple as equating a person’s birth date with their present-day risk.

A lot of it comes down to how people age: “There’s biological age and then there’s numeric age,” Cohen says. “There are a lot people [who] stay healthier longer throughout their life” who aren’t the same biological age as someone who is the same chronological age. Lifestyle factors — like how socially connected we are — can slow or accelerate the aging process.

Of course, in some cases people develop diseases like Type 1 diabetes that couldn’t be prevented, she notes; and those can directly or indirectly affect the aging process. But even proper management of chronic conditions can help mitigate that effect. 

Risks and complications from systolic hypertension

Left unchecked or untreated, systolic and diastolic hypertension can quietly wreak havoc on the body, and damage not only the heart but other organs from the brain to the kidneys.

Resulting vessel damage can reduce blood flow, which inhibits everything from eyesight to one’s sex life. Ultimately, it can lead to heart failure, heart attack and stroke, Lewis says, adding that it’s one of the drivers of kidney disease and kidney failure.

How can you prevent high systolic blood pressure?

Although age significantly raises a person’s risk of hypertension, experts emphasize that there are still ways to lower that risk.

“Many people will end up with hypertension, especially systolic hypertension,” Cohen says. “We know that over the age of 75, about 75 percent of adults have hypertension in general. So yes, it’s extremely common, but not inevitable.”

Prevention has everything to do with modifying the risk factors you can change.

“I use medications because I’m a doctor, but the best medicine is actually lifestyle — changing your lifestyle,” Singh says. “Diet, exercise, figuring out how to manage all of our stresses in a healthy way.”

Managing chronic conditions, like kidney disease, which can raise blood pressure in a number of ways, can also help. For example, diseased kidneys are less effective in ridding the body of salt, which causes the body to retain water, so that there’s more fluid in blood moving through the same size — often already hardened — blood vessel. (The dangerous effects flow in both directions: Restricted blood flow can damage the blood vessels in the kidney, reducing function and, in the worst case, leading to kidney failure.)

Always ask your doctor about the side effects of medications you’re taking — including if they can raise blood pressure, and whether alternatives are available, or if you should take a lower dose.

What are the treatment options and when should you consult your doctor?

To start, you should have a primary care doctor who you see regularly — though how often varies based on your need. For anyone 40 or older, it’s generally recommended that you get your blood pressure checked at least once a year. If your readings run high, you’ll also want to monitor your blood pressure at home regularly with a validated blood pressure device.  

Your doctor may prescribe blood pressure medication along with lifestyle changes to manage your numbers. If your systolic blood pressure is high but diastolic is low — a gap, called pulse pressure, that tends to grow with age — you’ll want to discuss how to balance treatment.

Extremely low diastolic blood pressure could be a marker of your body’s ability to get proper blood flow to all of your organs, Cohen said. This can mean a worsening of kidney function and “… can result in people having fainting episodes or losing consciousness or falling because they’re dizzy. So very, very low diastolic is worrying.”

But more often the much bigger danger is not adequately treating high systolic hypertension.

Where medications will lower both systolic and diastolic blood pressure, it doesn’t mean you shouldn’t take them, Cohen stresses; and any lifestyle changes that successfully lower blood pressure won’t make diastolic go too low, either. “Just have a conversation with your doctor about what symptoms to look out for if you are somebody who might be prone to having a low diastolic blood pressure.”