Having High Blood Pressure but a low pulse rate can be a sign of a more serious underlying health condition, such as a heart problem. Your blood pressure is the amount of pressure your blood is putting against the walls of your blood vessels. Blood pressure is considered high when it is above 130/80 millimeters of mercury (mm Hg). High blood pressure, or hypertension, is a common condition that affects nearly 1 in 2 adults.
Your Pulse, also known as heart rate, is the number of times your heart beats per minute. A normal pulse while resting is between 60 to 100 beats per minute (BPM). A heart rate of less than 60 BPM is considered slow. A slow or lowered heart rate is medically known as bradycardia. This condition is common in people while they sleep and is frequently seen in athletes.
High blood pressure can happen with extremely low heart rates because of a problem with your heart’s electrical or conduction system. The heart’s electrical system is responsible for determining your heart rate.
Specialized cells in the heart give off signals that travel throughout the heart. These signals tell your heart muscle to contract, which causes your heart to beat. Very low heart rates can happen when there is a disruption in your electrical system. In some cases, fixing the low heart rate with a pacemaker can help stabilize your blood pressure.
The combination of high blood pressure and low pulse can also occur due to Cushing’s reflex. This reflex causes three symptoms, commonly known as “Cushing’s triad:” low heart rate, high blood pressure, and abnormal breathing.
These symptoms can develop when there is an interruption of blood flow to the brain that activates other parts of the nervous system. This causes blood vessels to become narrow, which raises blood pressure. Cushing’s reflex also activates special receptors in the neck blood vessels that signal the heart to beat slower. You might develop these symptoms due to an increase of pressure in the brain due to a brain bleed, tumor, or brain swelling caused by trauma.
High blood pressure typically does not cause symptoms, which is why it’s sometimes referred to as The “Silent killer.”1 However, low pulse can cause the following symptoms, particularly at very low heart rates: Chest discomfort. Confusion. Fainting or feeling faint. Fatigue. Lightheadedness or dizziness. Trouble exercising or exercise intolerance. Weakness.
If you have high blood pressure and a low pulse, your treatment options will depend on the cause of the condition and its severity. Healthcare providers will commonly treat this condition with lifestyle recommendations and medications Several medications can help lower blood pressure, such as diuretics (water pills), beta-blockers, calcium channel blockers, and ACE inhibitors. Your healthcare provider will select a medication that best fits your needs. Alongside medication, your provider will also recommend lifestyle changes:
Eat more fruits and vegetables high in potassium.
Limit alcohol intake.
Lower your salt intake.
Maintain a weight that is right for you.
Manage your stress through techniques like yoga, meditation, or journaling.
Regularly exercise or participate in physical activity.
When a severely low heart rate accompanies high blood pressure, it’s essential also to treat the underlying cause. For severe bradycardia, such as from complete heart block (a total disruption of the heart’s conduction system), a pacemaker may be necessary. A pacemaker is a medical device placed within the heart to stimulate the heart to beat. The purpose of a pacemaker is to normalize your heart rate. Pacemakers can sometimes also lower high blood pressure.
If your high blood pressure and low pulse are due to Cushing’s reflex, you may be experiencing elevated pressure in the brain. The goal of treatment is to relieve the excess pressure. Treatment may involve draining cerebrospinal fluid (CSF)—which is the fluid that cushions your brain and spinal cord. In very rare cases, brain surgery may be necessary.
Both high blood pressure and low pulse can cause specific complications.
High blood pressure can cause or contribute to the following conditions: Aneurysm. Aortic dissection, or a tear in the wall of your blood vessel. Eye problems. Heart attack. Heart failure. Kidney disease. Stroke. Severely low pulse can cause the following complications: Cardiac arrest. Fainting. Frequent falls that may cause injury. Heart failure.
The best way to prevent high blood pressure and low pulse is to live a heart-healthy lifestyle and treat any underlying conditions. The American Heart Association recommends “Life’s Essential Eight” to keep a healthy heart, which includes the following eight lifestyle recommendations:
Eat a heart-healthy diet high in fruits and vegetables, legumes, and whole grains, while limiting intake of processed foods, salt, and trans fats.
Get regular physical activity, usually about 2.5 hours of exercise per week.
Quit tobacco use, including smoking cigarettes, cigars, and vapes.
Prioritize getting adequate sleep, usually between 7 to 9 hours per night.
Maintain a healthy weight that is right for your body type.
Control your cholesterol levels.
Keep an eye on your blood sugar to ensure it’s in a normal range.
Ensure your blood pressure is in a healthy range, which is usually 120/80 millimeters of Mercury (mmHg).
If you are concerned about high blood pressure and a low heart rate, it’s important to see your healthcare provider for an evaluation. Modern-day fitness trackers and watches can measure your pulse. But you can also check your pulse by placing two fingers on one side of your neck just below the jawline. Count how many beats you feel in one minute. If your heart rate at rest is less than 60 BPM and you have symptoms like fatigue or dizziness, you should seek medical attention. You should also seek immediate medical care for concerning symptoms or symptoms that could be due to a heart attack, such as new shortness of breath, chest discomfort, nausea, or lightheadedness.
High blood pressure and low pulse can be a sign of a serious condition, such as severe heart conduction abnormalities like complete heart block. Cushing’s reflex due to high pressure in the brain can also cause high blood pressure with a low pulse. Symptoms of a seriously low heart rate include fatigue, lightheadedness, fainting, and chest discomfort. Treatment of high blood pressure and a low pulse usually involves a mix of lifestyle changes and medication.
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