Systolic blood pressure is the pressure exerted on the walls of the arteries at the moment of maximum force during a heartbeat, when the left ventricle contracts and ejects blood into the aorta. It is the higher of the two numbers in a blood pressure reading (expressed as systolic over diastolic, for example 120/80 mmHg) and represents the peak arterial pressure during each cardiac cycle.
Normal systolic blood pressure for most adults at rest is considered below 130 mmHg. Systolic blood pressure generally rises with age as the aorta and large arteries stiffen; isolated systolic hypertension (elevated systolic with normal diastolic) is the most common form of hypertension in older adults. Even a reduction of 10 mmHg in systolic blood pressure is associated with a significant reduction in major cardiovascular events.
In the intensive care unit following cardiac arrest, maintaining adequate systolic blood pressure is a core goal of haemodynamic management. Vasopressor medications are used to support systolic blood pressure when myocardial stunning or systemic vasodilation cause hypotension in the early post-arrest period. Current guidance suggests targeting a systolic blood pressure of at least 100 mmHg in the immediate post-arrest phase.
For cardiac arrest survivors discharged from hospital, good systolic blood pressure control is an important component of long-term secondary prevention. Home blood pressure monitoring helps track control, and regular review with the GP or cardiac team allows medication to be adjusted as needed.
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