There are two major types of hypertension and four more not so common types. 

The two major types are: Primary or essential hypertension and Secondary hypertension. The other types include: Malignant Hypertension, Isolated Systolic Hypertension, White Coat Hypertension and Resistant Hypertension.

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Isolated Systolic Hypertension

In this case the systolic blood pressure, (the top number), is consistently above 160 mm Hg, and the diastolic below 90 mm Hg. This may occur in older people, and results from the age-related stiffening of the arteries. The loss of elasticity in arteries, like the aorta, is mostly due to arteriosclerosis. The Western lifestyle and diet is believed to be the root cause.

Latest studies confirm the importance of treating Isolated Systolic Hypertension as it significantly reduces the incidence of stroke and heart disease. Treatment starts with lifestyle modification, and if needed, added drugs.

Do not discard elevated systolic readings
Patients with an elevated systolic reading only, should not dismiss it as a mere age-related condition.  Clinically, it is associated with increased heart attacks, heart failure and stroke.

In this case the systolic blood pressure, (the top number), is consistently above 160 mm Hg, and the diastolic below 90 mm Hg. This may occur in older people and results from the age-related stiffening of the arteries. The loss of elasticity is mostly due to arteriosclerosis. The increase in blood pressure with age, is more pronounced in civilized countries. The Western lifestyle and diet is the main culprit.

Isolated Systolic Hypertension needs to be distinguished from white coat hypertension, an anxiety-induced condition, with high readings when taken by your doctor. Typically, measurements outside the clinical setting are normal.  Female patients and the elderly are more prone to white coat hypertension. 24-hour blood pressure monitoring may sometimes be necessary to make the diagnosis. 

Isolated Systolic Hypertension can also be confused with essential hypertension of later onset. Essential or primary hypertension has no obvious cause, and may sometimes only be diagnosed later in life. In this case, both the systolic and the diastolic readings are higher. 

In patients older than 50 years the systolic reading is very important, whether elevated due to essential hypertension or Isolated Systolic Hypertension. In Isolated Systolic Hypertension, however, the diastolic should not be decreased to below 65 – 70 mm Hg.

Latest studies confirm the importance of treating Isolated Systolic Hypertension, as doing so significantly reduces the incidence of stroke and heart disease. Treatment starts with lifestyle modification, and if needed, medication like diuretics are added.

Dr Kathleen Coetzee, MBChB 

Read more:
Hypertension and essential fatty acids
The symptoms of hypertension

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