Blood Pressure 138/66 mmHg: What Does It Indicate?

Michael Rotman, MD, FRCPC, PhD | Medically reviewed by Robin Backlund, BHSc Last update:

What is isolated systolic hypertension (ISH)?

ISH is a form of blood pressure disorder that affects 1-5% of the population based on demographics, while it affects more than 15% of the elderly population over 60 years, according to a STATPearl publication by Dr. Jian Liang Tan & Dr. Kshitij Thakur.

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This condition deviates from general hypertension, where both systolic and diastolic pressures are elevated.

ISH is significant as it isolates systolic pressure, highlighting the impact of arterial stiffness, particularly in the elderly, though it’s not exclusive to this demographic.

The prevalence of ISH increases with age, making it a common condition among older adults. This rise is attributed to the natural loss of elasticity in the arteries over time, which leads to higher systolic pressure even as diastolic pressure may decline or remain stable.

However, younger individuals are not immune, especially in the presence of certain lifestyle factors or health conditions that can accelerate arterial stiffness.

According to a 2008 review published by two doctors from The Ottawa Hospital, Canada, ISH poses a substantial risk.

The elevated systolic pressure exerts excessive force against the arterial walls, leading to a cascade of changes within the cardiovascular system.

This strain can result in hypertrophy of the left ventricle, increased risk of coronary artery disease, and heightened workload for the heart.

Over time, these effects can compromise heart function and increase the risk of heart failure, stroke, and other cardiovascular diseases.

The severity of ISH should not be underestimated. It is associated with a significant increase in the risk of cardiovascular events and mortality, especially when left untreated or poorly managed.

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The chronic elevation of systolic blood pressure can lead to persistent damage to the blood vessels and vital organs, progressively undermining the body’s cardiovascular health.

Sustained ISH accelerates the natural wear and tear on the cardiovascular system.

Prolonged elevation of systolic blood pressure can lead to permanent damage to your cardiovascular system, enhancing the likelihood of catastrophic events such as heart attacks and strokes.

The progression of these changes underscores the critical need for early detection and management of ISH to mitigate its long-term impact on cardiovascular health.

Now that you know the pathophysiology of this disorder, let us jump into the various symptoms exhibited by this condition.

What are the symptoms of isolated systolic hypertension?

ISH might not exhibit symptoms in the early onset; however, when it turns chronic, you may be able to identify a few of them.

These symptoms of ISH, along with a systematic assessment of blood pressure, can help your doctor confirm this condition.

Below are some of the key symptoms and signs associated with an ISH of 138/66 mmHg, as shared by the Mayo Clinic.

• Elevated systolic blood pressure readings: The most definitive sign of ISH is a systolic blood pressure reading of 130 mmHg or higher, while the diastolic pressure stays below 80 mmHg.
• Fatigue: Individuals may experience general feelings of tiredness or fatigue without exertion.
• Headaches: Frequent, unexplained headaches can be a symptom of ISH, often occurring in the morning.
• Dizziness: Episodes of dizziness or lightheadedness may occur, potentially increasing the risk of falls, especially in older adults.
• Pounding in the ears or chest: A sensation of throbbing or pounding in the ears or chest, which may be more noticeable during periods of rest or at night.
• Shortness of breath: Difficulty breathing or shortness of breath during routine activities that previously did not cause such symptoms.
• Vision problems: Blurred or impaired vision can be a sign of ISH, resulting from the high pressure affecting the blood vessels in the eyes.
• Confusion or difficulty concentrating: High systolic pressure can affect cognitive functions, leading to moments of confusion or trouble focusing.

These symptoms and their severity might change depending on individual physiology. However, the causative factors of ISH mostly remain the same for everyone. Let us learn more about it in the upcoming section.

What are the causes of isolated systolic hypertension?

ISH can occur due to a multitude of reasons. Sometimes, it could be because of lifestyle-related factors, while other times, it is genetic.

It is a common condition, particularly among older adults, due to various factors related to aging and lifestyle.

Below are some of the major causative factors according to a 2016 publication authored by Chirag Bavishi, MD, MPH, and colleagues in the American Journal of Medicine.

• Age-related arterial stiffness: As people age, their arteries can become less elastic, causing the systolic blood pressure to increase. This is the most common cause of ISH in the elderly.
• Unhealthy lifestyle habits: Poor dietary choices, deficiency of physical activity, high alcohol use, and smoking can contribute to the development of ISH.
• High salt intake: Consuming a diet high in salt can lead to increased blood pressure, particularly affecting the systolic reading.
• Obesity: Excess BMI is a significant risk factor for ISH, as it can increase the workload on the heart and arteries.
• Lack of physical activity: A sedentary lifestyle or job can lead to higher systolic blood pressure by contributing to obesity and arterial stiffness.
• Genetics: ISH has a genetic component, meaning it can run in families.
• Medical conditions: Specific medical ailments like diabetes, renal disorders, and thyroid issues can play a role in the onset of ISH.
• Medications: Some medications, including over-the-counter pain relievers, cold remedies, and antidepressants, can raise systolic blood pressure.

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It’s important to understand these factors as they could be key in deciding the treatment regime prescribed by your doctor for effective management of ISH.

Furthermore, for your knowledge, below is an explanation of how ISH could pose a risk or danger. Keep reading further.

What are the risks and dangers associated with isolated systolic hypertension?

There are numerous risks and dangers when the blood pressure readings consistently show 138/66 mmHg. It could have a detrimental effect on the quality of life over time when left untreated.

A team of researchers from Shahid Beheshti University of Medical Sciences published an article in the journal Blood Pressure, which highlights some of the most prevalent risks and dangers of ISH, as given below.

• Heart disease: ISH increases the strain on the heart, leading to a higher risk of coronary artery disease, heart failure, and enlarged heart.
• Stroke: Elevated systolic blood pressure can lead to weakened or narrowed blood vessels in the brain, increasing the risk of stroke.
• Kidney damage: ISH can damage the arteries around the kidneys, affecting their ability to filter blood effectively, leading to kidney disease.
• Vision loss: Hypertension can damage the delicate blood vessels in the eyes, leading to retinopathy, which can result in vision impairment or loss.
• Cognitive decline: There is an association between ISH and an increased risk of cognitive decline, including memory loss, difficulty with concentration, and, in severe cases, dementia.
• Arterial damage: High systolic pressure can stiffen and thicken artery walls (atherosclerosis), reducing blood flow to vital organs.
• Aneurysm formation: The pressure can cause the blood vessels to bulge (aneurysm), increasing the risk of rupture, which can be life-threatening.

Regular blood pressure monitoring and steps to manage hypertension are key to preventing the severe consequences associated with isolated systolic hypertension.

Check out the next section to gather a basic idea of the existing treatments for ISH.

How do you treat isolated systolic hypertension?

Treating an ISH of 138/66 is crucial for reducing the risk of cardiovascular diseases and improving overall health.

Management and treatment strategies involve a combination of lifestyle changes and medication. Below are the primary approaches as elaborated by Prof. Gordon in his 2006 publication on Current Hypertension Reports.

Lifestyle modifications

• Dietary changes: Adopting a heart-healthy diet that is low in salt, saturated fats, and cholesterol. Increment the intake of fruits, vegetables, and whole grains.
• Weight management: Achieving and maintaining a healthy BMI can significantly take care of high blood pressure and the risk of complications.
• Regular physical activity: Engaging in moderate-intensity exercise, such as brisk walking, for at least 150 minutes per week.
• Limiting alcohol consumption: Keeping alcohol intake to a moderate level. For most adults, this means up to one drink a day for women and up to two drinks a day for men.
• Quitting smoking: Smoking cessation not only lowers blood pressure but also reduces the risk of heart disease and improves overall health.

Medication & checkup

• Antihypertensive drugs: Depending on individual health profiles, doctors may prescribe medications such as diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, or beta-blockers.
• Monitoring and adjustments: Regular blood pressure monitoring is necessary to ensure the effectiveness of treatment. Use a clinically proven device like Oxiline Pressure X Pro, CheckMe BP2 or Omron Silver.
• Healthcare visits: Regular visits to a healthcare provider for blood pressure monitoring and assessment of cardiovascular health.

It’s important to work closely with your doctor to develop a personalized treatment plan for ISH.

Treatment goals include not only lowering systolic blood pressure to within the target range but also addressing any other health issues to reduce the overall risk of cardiovascular events.

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