Rationale: Elevated systolic blood pressure with normal values of diastolic is significant risk factor for cardiovascular mortality and higher incidence of strokes.This is specifically marked in elderly patients. Borderline isolated systolic hypertension is in the range between 140 and 159 mmHg, while the value of 160 mmHg and higher is classified as hypertensive disease. Objective: The purpose of this paper is to review the isolated systolic blood pressure in patients with normal diastolic in the same time. And also to present the current approach to the menagement of such individuals. Method and Material: Systolic hypertensive patients, in general elderly, over the 65 years old are included in this review paper.The open clinical study with decision making approach concept has been designed. Diagnosis and therapy for each patients has been specifically individualized. Discussion: Management of elderly patients who often present with isolated values of high systolic blood pressure is in many cases underestimated. Approach to such individuals requires careful monitoring for detection of undelying process and stratification for risk factors important for developing atherosclerosis and hypertensive vascular disease. The specific diagnostic study and evidence based medicine for treatment should be undertaken in management procedure.