Alok Gupta, 56 years old, was surprised to find that his BP was on the higher side when he got himself checked at one of the free medical camps that he casually went to in his area. His doctor advised Gupta to check his blood pressure again so that the right course of action can be decided.

Subsequently, he checked his blood pressure twice and his systolic pressure was consistently high. Gupta was suffering from isolated systolic hypertension. A systolic value of >140 mmHg with no rise in diastolic value is isolated systolic hypertension and requires medication.

Doctors stress on regular examination of blood pressure, especially with an increase in age. Says Dr Nagaraj Desai, Director and senior consultant cardiologist, Apollo Hospital, "Most people don't know that blood pressure rises with age. This is particularly true with systolic blood pressure, which increases with age. And isolated systolic hypertension is particularly common in the elderly."

Less elastic

The combination of hypertension and ageing causes blood vessels to become less elastic. This is the reason for the increase of systolic blood pressure found in elderly hypertensive individuals, adds Dr Desai.

The systolic blood pressure increases with age because the aorta stiffens. Therefore, even people with healthy blood pressure at 55 years are seen to have hypertension at age 75. The cut off age for an elderly person in India is 60-65 years and 6th Joint Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC-VI) has identified it as above 60 years.

Explains Dr Desai, "Isolated systolic hypertension (ISH) is the commonest form of hypertension in the elderly, and accounts for about 60% of all hypertensive conditions in the population aged over 65 years. Isolated systolic hypertension (ISH) means SBP > 140 mm Hg with DBP < 90 mm Hg." But does the presence of ISH mean that you require urgent attention? Yes you do. As per the WHO-International Society for Hypertension, overall prevalence of hypertension in elderly individuals is 65% in India.

And hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.  Experts feel that ISH constitutes independent cardiovascular risk factors and needs urgent medical treatment.

ARE YOU AT RISK?

So is your BP number above 140? Are you suffering from diabetes? Are you a patient of kidney or heart failure? Are you suffering from high blood pressure over many years? If the answer to any of these questions is yes, you need to keep your blood pressure under tight control with medication.

Remember that you need medication for ISH if the systolic BP number is above 140. Having diabetes makes it more difficult to treat ISH. In people with kidney failure or heart failure, blood pressure should be kept at the lowest level tolerated (i.e., without getting symptoms such as lightheadedness). Blood pressure should be lowered slowly in older people with longstanding, severe systolic high blood pressure.