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  • Isolated Systolic Hypertension (ISH)

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    Old 11-23-2007, 11:07 PM   #1
    FRANKNZL
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    Isolated Systolic Hypertension (ISH)

    Hello all, my first post. my Doctor has recently told me that I have a high systolic reading of about 170, but a low diastolic reading of about 70. I am a fit 66 year-old man and I regularly walk 5 km a day without feeling any distress.

    I have read on internet that my condition is known as "isolated systolic hypertension" (ISH). In the first instance, I would prefer to try and lower my blood pressure through natural means, rather than drugs. I am concerned that, if I go on to drugs, my diastolic reading might go too low. Do you think it is better to try and use dietary measures in the first instance? Any tips for food types etc would be appreciated.

    I am not overweight at present. But if I do go on to drugs, is there one particular drug that is best for people with ISH (i.e. one that will lower the systolic reading without lowering the diastolic reading too much)? How long do you think I should continue with dietary / exercise measures before going on to a drugs regime? Is it safe to fly on planes with a 170 bp?

    Thanks very much for your help.

    Fred

     
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    Old 11-30-2007, 04:18 PM   #2
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    Re: Isolated Systolic Hypertension (ISH)

    Quote:
    Originally Posted by FRANKNZL View Post
    Hello all, my first post. my Doctor has recently told me that I have a high systolic reading of about 170, but a low diastolic reading of about 70. I am a fit 66 year-old man and I regularly walk 5 km a day without feeling any distress.

    I have read on internet that my condition is known as "isolated systolic hypertension" (ISH). In the first instance, I would prefer to try and lower my blood pressure through natural means, rather than drugs. I am concerned that, if I go on to drugs, my diastolic reading might go too low. Do you think it is better to try and use dietary measures in the first instance? Any tips for food types etc would be appreciated.

    I am not overweight at present. But if I do go on to drugs, is there one particular drug that is best for people with ISH (i.e. one that will lower the systolic reading without lowering the diastolic reading too much)? How long do you think I should continue with dietary / exercise measures before going on to a drugs regime? Is it safe to fly on planes with a 170 bp?

    Thanks very much for your help.

    Fred
    Since writing the above, I have done some research on internet, and I came across an interesting article by Peter A. van Zwieten which focuses on the drug treatment of isolated systolic hypertension (ISH). This article discusses the widened pulse pressure that is typically found in the elderly and which is the product of an increase in systolic and a decrease in diastolic pressure.

    Theoretically, it seems desirable to develop a drug that reduces systolic blood pressure (SBP) while not reducing so markedly diastolic blood pressure (DBP). It seems that the drug, "spironolactone" helps to counter arterial stiffness, which is the pathogenetic mechanism that underlies ISH.

    Another drug, "isosorbide dinitrate" can apparently reduce SBP without altering DBP. This is my main worry, that is, I do not want to take a drug that reduces my DBP, which is usually below 70. I would prefer to have a drug that focuses primarily on my high SBP.

    If anyone has experience with ISH, spirinolactone or isosorbide dinitrate, I would be interested to hear from you.

    Regards, Frank

     
    Old 11-30-2007, 08:35 PM   #3
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    Re: Isolated Systolic Hypertension (ISH)

    Hi Frank,

    Some doctors feel that lowering systolic blood pressure past certain margin in Isolated systolic hypertension will result in an excessively low diastolic pressure. As a result, they do not aim for target level of systolic blood pressure as long as the diastolic blood pressure is on or below the goal.
    Generally, in ISH target blood pressure is difficult to achieve, especially in older people. This is due to age related arterial stiffness. This type of hypertension is more difficult to control than diastolic hypertension. If the elevation in blood pressure is >20/>10, a combination of antihypertensive agents should be used right from the start. The medications can be taken in smaller doses with fewer side effects. One of the meds should be a diuretic. Spironolactone, eplerenone, ACEs and ARBs have all been shown to help reduce arterial stiffness. Other methods that will help de-stiffening of the arteries are the use of statins, antioxidants, aerobic exercise and a reduced sodium diet. All of these should prove helpful in reduction of arterial stiffness and thus blood pressure.

    I have been on Spironolactone for a year now. The only notable side effect I've had from this medication so far were hormonal changes. Males are affected in a similar manner. On the plus side, Spironolactone helps reverse some of the remodeling and left ventricular hyperthropy. Long-term effects of this drug on people are not known.

    Good luck with your treatment!

    flowergirl

     
    Old 12-01-2007, 06:20 AM   #4
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    Re: Isolated Systolic Hypertension (ISH)

    Frank,

    First I would make sure that your figure of 170 is as accurate as possible. Get a good b/p monitor & check your b/p under all kinds of situations. Be sure to check your b/p monitor against the Dr's b/p equipment for accuracy.

    Find a list of possible causes of HBP & go down the list with a fine tooth comb. For example, check your water for lead. Make sure your Dr. has done the appropriate blood & urine tests to find a cause of HBP.

    I would try all the lifestyle stuff first before taking meds. Although Dr's make lite of the side effects of b/p meds, some can be quite serious. For example, I have permanent damage to my knees, upper arms, & hands from Cozaar which I only took for 13 days. There isn't a way at the moment for forcasting beforehand who will be affected adversely beforehand. Mayo Clinic does have some blood tests for some heart drugs to see if they will work in an individual patient.

    Duiretics namely HCTC would be my first choice drug for ISH. It reduced my systolic without affecting my diastolic when nothing else would. Then Norvasc which is known to reduce systolic b/p. I couldn't take the side effects. Fam

    Last edited by famnd; 12-01-2007 at 06:22 AM.

     
    Old 12-02-2007, 12:59 AM   #5
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    Re: Isolated Systolic Hypertension (ISH)

    Thanks very much flowergirl and famnd for your valuable advice. I will certainly try all the lifestyle stuff before agreeing to drug treatment, provided that my bp does not increase further in the meantime. But I just wanted to be familiar with some of the main drugs well in advance, just in case this becomes the only option.

    Regards, Frank

     
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