Why Do I Have High Blood Pressure But a Low Pulse?

By Jennifer Nadel, MD
Medically reviewed checkmarkMedically reviewed
December 22, 2022

Many times, high blood pressure (hypertension) and increased pulse (or heart rate) occur together. However, some people with hypertension have low pulses. This may seem contradictory, but there’s usually an underlying cause that may or may not indicate a health problem.

In this article, I’ll clarify the difference between blood pressure and pulse. Then I’ll explain what can cause someone to have high blood pressure with a low pulse as well as the relationship between blood pressure and heart rate. Lastly, I’ll discuss when high blood pressure and a low pulse is a concern to discuss with your doctor. No matter your situation, there are ways to manage it and keep your heart as healthy as possible.

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What’s the Difference Between Blood Pressure and Pulse?

Blood pressure and pulse readings both reflect the state of your heart, blood vessels, and overall health. Blood pressure is the pressure generated by blood moving through your blood vessels. High blood pressure is a reading greater than 130/80 mmHg. A diagnosis of hypertension comes from repeated elevated blood pressure readings in a clinical office setting. 

Your pulse (also known as your heart rate) is the number of times your heart beats per minute. A normal resting pulse rate ranges between 60-100 beats per minute. A resting pulse above 100 beats per minute is referred to as tachycardia, while a resting pulse below 60 beats per minute is bradycardia.

Heart rate can increase for any of the following reasons: 

  • Physical activity: Exercise increases pulse because the heart beats faster to supply active muscles with blood and oxygen. 
  • Substance use: Anything that contains caffeine (such as coffee) and stimulant drugs (like cocaine and methamphetamines) can raise pulse rate.
  • Stress: Mental stress—including anxiety, fear, or emotional distress—can temporarily  increase pulse rate. 

What Causes High Blood Pressure and a Low Pulse? 

People with hypertension typically have an elevated heart rate. An increased pulse is also associated with the development of hypertension. But some people with high blood pressure have a slow heart rate (bradycardia). This may happen due to specific medications, thickened heart tissue, or certain injuries.

Blood pressure medications

Since many people with high blood pressure also have a high pulse, some anti-hypertensive medications lower the heart rate so the heart doesn’t have to work as hard. Beta-blockers such as metoprolol and atenolol are commonly prescribed to manage hypertension. These medications also decrease heart rate. Propranolol, another type of beta-blocker, is sometimes prescribed by doctors as an anxiety medication.

Thickened heart tissue

High blood pressure makes the heart work harder to pump blood through the blood vessels. In a mechanism similar to how consistent vigorous exercise causes muscles to grow thicker over time, the heart also thickens with long-term overwork.

Thickened heart tissue can change the way electrical signals are transmitted within the heart. This can lead to reduced or increased pulse, or make the heart beat irregularly. Thickened heart tissue can also lower the pulse by making the heart too stiff to contract forcefully enough.

What’s the Relationship Between Blood Pressure and Heart Rate?

Generally speaking, increased heart rate is associated with increased blood pressure. This means that having a higher heart rate can increase the risk of developing hypertension. 

For people diagnosed with hypertension, also having a high heart rate increases the risk for heart disease. So it’s important for these individuals to monitor not only their blood pressure but also their heart rate.

What Can High Blood Pressure and Low Pulse Indicate?

A low pulse may indicate health problems like:

  • Metabolic disorders like low thyroid hormone
  • Heart tissue damage from heart disease or heart attack
  • Dysfunction of the heart’s natural pacemaker, known as the sinus or sinoatrial node
  • Problems in the heart’s electrical pathways 

A person on medications that lower heart rate, like beta blockers, non-dihydropyridine calcium channel blockers, and ivabradine, may also experience low pulse. 

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When Should I Be Concerned About High Blood Pressure and a Low Pulse?

It’s best to work with a healthcare professional to help monitor high blood pressure and low (or high) pulse.

For most people, this means creating a care plan with your doctor if:

  • Your blood pressure is consistently higher than 130/80 mm Hg
  • Your pulse is consistently lower than 60 beats per minute
  • Your pulse is consistently higher than 100 beats per minute 

No matter your pulse, if your blood pressure is higher than 180/120 mm Hg, rest for five minutes and test again. If your blood pressure remains elevated but you don’t have any other symptoms, contact your doctor.

But if your blood pressure is very high and you experience any of the below, call 911 or head to the emergency room:

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Frequently Asked Questions

Why is my heart rate low when my blood pressure is high?
If you are hypertensive, a low heart rate could be caused by blood pressure medications such as beta-blockers or by changes in your heart muscle. High blood pressure can cause the heart to thicken, which could affect its electrical system and result in a lower pulse.
How do you fix low heart rate and high blood pressure?
The fix for low heart rate and high blood pressure depends on the cause. If it’s due to medication, your doctor may prescribe another class of antihypertensives, such as calcium channel blockers, angiotensin receptor blockers, or angiotensin-converting enzyme (ACE) inhibitors. However, if a low heart rate occurs as a result of prolonged high blood pressure leading to heart thickening and causing irregular heartbeats, this can be addressed by interventions such as cardiac ablation or inserting a pacemaker.
What is a dangerously low heart rate?
The normal resting heart rate is between 60-100 beats per minute. Doctors typically consider a heart rate below 60 beats per minute to be low. However, people who exercise often—such as athletes—can have resting heart rates as low as 40 beats per minute. For most people, a heart rate below 60 that’s accompanied by symptoms such as dizziness, weakness, fainting, difficulty breathing, chest pain, or heart palpitations might indicate a more serious problem that requires urgent medical attention.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jennifer Nadel, MD

Dr. Jennifer Nadel is a board certified emergency medicine physician and received her medical degree from the George Washington University School of Medicine. She has worked in varied practice environments, including academic urban level-one trauma centers, community hospital emergency departments, skilled nursing facilities, telemedicine, EMS medical control, and flight medicine.

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