High blood pressure and a low pulse is a rare occurrence. Some medical conditions and medications can cause this condition to occur.

A person’s pulse rate, which indicates their heart rate, is how many times the heart beats per minute. Doctors usually consider a low pulse as less than 60 beats per minute. They call this bradycardia.

Blood pressure is the measure of the force of blood inside the blood vessels. High blood pressure can overload the circulatory system, increasing the risks for heart attack and stroke.

Most doctors consider high blood pressure as greater than 130/80, according to the new guidelines released by the American Heart Association.

Severely high blood pressure is pressure greater than 170/100.

In this article, we take a look at the possible causes of high blood pressure with a low pulse.


Beta-blockers

a doctor checking a person pulse for High blood pressure and low pulse
Some medical conditions or medications can cause high blood pressure and a low pulse.

Beta-blockers are a class of drugs that doctors sometimes prescribe to treat high blood pressure and reduce the effects of heart failure.

Examples of beta-blockers include:

atenolol (Tenormin)

metoprolol (Lopressor, Toprol XL)

nebivolol (Bystolic)

propranolol (Inderal)

These medicines work to block beta receptors in the heart. Stimulating these receptors increases heart rate while blocking them decreases heart rate.

A lower heart rate is beneficial for a person who has heart problems because it allows more time for the heart to fill. When the heart beats slower, it also requires less oxygen. This places less strain on the heart and “rests” the heart.

Doctors will sometimes prescribe beta-blockers to people who have high blood pressure, congestive heart failure, or a cardiac arrhythmia when the heart beats irregularly. For this reason, a person who already has high blood pressure can have a lower heart rate with beta-blockers.

Treatments

Doctors can also prescribe other medications to reduce blood pressure, including:

calcium channel blockers

angiotensin receptor blockers

angiotensin converting enzyme inhibitors

These drugs do not usually affect the heart rate while treating blood pressure.

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Cushing reflex

The Cushing reflex is a rare occurrence that causes a low pulse and high blood pressure.

The reflex is the result of the body’s response to increased intracranial pressure. Intracranial pressure is the pressure inside the head and is a measurement of blood pressure in the brain.

The brain rests inside a person’s skull, so, if it swells, there is only so far it can expand. As a result, swelling causes intracranial pressure to increase.

The Cushing reflex is one of the body’s ways to try and keep pressure from getting too high in the skull. It signals receptors in the heart to slow the heart rate down to lower the intracranial pressure.

Severe medical conditions usually activate the Cushing reflex. These conditions include:

Treatments

The Cushing reflex is an emergency. Once doctors recognize this condition, their goal is to try and treat the cause and reduce the intracranial pressure in the brain. If the pressure gets too high, it can permanently damage the brain. A person can die from excessively high intracranial pressure.


Problems with heart conduction

A low pulse rate can sometimes be an indicator of a problem with the heart’s electrical conduction pathway.

The heart has an electrical system that travels in a distinct pattern to make the heart beat with a regular rhythm. If there is damage, scarring, or overstretching of the heart, the electrical system may not work as effectively. This can cause a low pulse rate.

Chronic high blood pressure can contribute to damage to the electrical system that, in turn, leads to a low pulse rate. Other causes of damage include smoking, a history of heavy drug or alcohol use, or aging of the heart.

Treatments

A person whose pulse suddenly seems to be slowing down for no known reason should see a doctor. This is especially true if they feel dizzy or short of breath.

On certain occasions, a person may require a pacemaker or other intervention, such as cardiac ablation, to repair the damaged electrical heart pathways.

When to see a doctor

a doctor sharing results with an elderly patient
If a person experiences chest pains along with a low pulse and high blood pressure, they should speak to their doctor.

A person should seek immediate medical attention if they have the following symptoms along with a low pulse and high blood pressure:

dizziness or lightheadedness

feeling faint or fainting

shortness of breath

chest pains

These symptoms may indicate that a person requires a hospital stay and possibly a pacemaker to treat whatever is causing their underlying heart problem.


Outlook

High blood pressure and a low pulse rate is a fairly rare occurrence. People are more likely to have high blood pressure alone unless they take medications that may affect their pulse rate.

Certain medicines in individuals with high blood pressure can result in a low pulse rate and high blood pressure. Rarely, an increase in intracranial pressure can induce the Cushing reflex and a low pulse rate and high blood pressure.

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