What characterizes isolated systolic hypertension and in which population is it most common?

• A. Elevated SBP with normal or near-normal DBP; most common in older adults due to arterial stiffening.
• B. Elevated DBP with low SBP; common in young adults.
• C. Both SBP and DBP elevated equally in all adults.
• D. Normal SBP and DBP.

Answer: (A)

Isolated systolic hypertension is defined by an elevated systolic blood pressure with a normal or near-normal diastolic pressure. This pattern occurs mainly in older adults because the arteries become stiffer with age, losing their elastic recoil. When the large arteries don’t stretch as well, the pressure wave that pushes blood through the circulation is amplified, raising the systolic value. At the same time, diastolic pressure may stay the same or even drop because the stiff arteries don’t recoil as effectively during diastole. The result is a widened pulse pressure, which is a hallmark of this condition.

That’s why this pattern is most common in older adults: age-related arterial stiffening drives the high systolic reading while diastolic pressure remains normal or low. In contrast, patterns like high diastolic pressure with low systolic pressure, or both numbers being elevated, don’t fit isolated systolic hypertension. Normal readings would not indicate hypertension.