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Systolic Blood Pressure: What the Top Number Means
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What is it?
Blood pressure (BP) is the force exerted on the walls of arteries by blood moving around the body. It is determined by the force at which the heart pumps and also the stiffness of the arterial walls. Our blood pressure can vary a lot throughout the day and will increase when we are stressed or exercising as our body tries to bring more blood to our muscles and brain.
Blood pressure is recorded as two numbers:
- Systolic blood pressure (the first number) - indicates how much pressure your blood is exerting against your artery walls when the heart contracts.
- Diastolic blood pressure (the second number) - indicates how much pressure your blood is exerting against your artery walls while the heart muscle is resting between contractions.
Why it matters
The walls of our arteries become progressively stiffer as we age which leads to a general increase in blood pressure. This occurs faster in some people than others and is associated with numerous possible causes including genetic factors, exercise, sex, and chronic conditions such as type 2 diabetes. Chronically high blood pressure, or “hypertension”, puts pressure on the heart when it's pumping leading to progressive damage to the heart muscle and increasing the risk of heart failure. The high pressure also impacts the small blood vessels which leads to damage in several organs including the kidneys, brain, and eyes.
Numerous epidemiological studies have shown that as blood pressure rises above around 115/75 mmHg the risk of heart disease and stroke also increases significantly. Conversely, treating blood pressure with antihypertensive medications has been shown to reduce the risk of these diseases. All of this points to the fact the monitoring and controlling blood pressure is an essential part of a proactive health plan.
Reference ranges
- Normal blood pressure - Systolic <120 mmHg and diastolic <80 mmHg
- Elevated blood pressure - Systolic 120 to 129 mmHg and diastolic <80 mmHg
Hypertension:
- Stage 1 - Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
- Stage 2 - Systolic at least 140 mmHg or diastolic at least 90 mmHg
If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage. '
Blood pressure ranges taken from the American College of Cardiology/American Heart Association consensus in 2017.
Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., et al. (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension. [Online] 71 (6), e13–e115. Available from: doi:10.1161/hyp.0000000000000065.
Select epidemiological studies:
Pozarickij, Alfred et al. “Causal relevance of different blood pressure traits on risk of cardiovascular diseases: GWAS and Mendelian randomisation in 100,000 Chinese adults.” Nature communications vol. 15,1 6265. 24 Jul. 2024, doi:10.1038/s41467-024-50297-x
Staplin, Natalie et al. “Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients.” Lancet (London, England) vol. 401,10393 (2023): 2041-2050. doi:10.1016/S0140-6736(23)00733-X
Ettehad, Dena et al. “Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.” Lancet (London, England) vol. 387,10022 (2016): 957-967. doi:10.1016/S0140-6736(15)01225-8
This information is educational and does not replace medical advice, diagnosis, or treatment. Your results should be interpreted with a qualified healthcare professional in the context of your health history.
