Health Conditions A-Z Cardiovascular Disorders Hypertension What Does It Mean to Have High Blood Pressure and a Low Pulse? By Angela Ryan Lee, MD Angela Ryan Lee, MD Angela Ryan Lee, MD, FACC, is a board-certified cardiology and internal medicine physician. She also holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. health's editorial guidelines Updated on December 15, 2023 Medically reviewed by Christopher Lee, MD Medically reviewed by Christopher Lee, MD Christopher Lee, MD is a board-certified cardiologist and internal medicine physician. learn more Close Cravetiger / Getty Images Blood pressure and pulse are measurements that can provide important information about your health. Your blood pressure is the amount of pressure that 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 American 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 also frequently seen in athletes. Having high blood pressure, but a low pulse rate can be a sign of a more serious underlying health condition. Knowing what causes this condition and learning its symptoms can be an important step in understanding when to seek medical attention and get the support you need. Causes 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". The three symptoms are low heart rate, high blood pressure, and an abnormal breathing pattern. 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. Symptoms High blood pressure typically does not cause symptoms, which is why it's sometimes referred to as the "silent killer." However, low pulse can cause the following symptoms, particularly at very low heart rates: Fatigue Weakness Lightheadedness or dizziness Chest discomfort Trouble exercising or exercise intolerance Fainting or feeling faint Confusion Treatment 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 is best fit for your individual needs. Alongside medication, your provider will also recommend lifestyle changes, which may include: Lowering your salt intake Eating more fruits and vegetables that are high in potassium Regularly exercising or participating in physical activity Limiting alcohol intake Managing your stress through techniques like yoga, meditation, or journaling Maintaining a weight that is right for you When a severely low heart rate accompanies high blood pressure, it's essential to also 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 that is 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. Complications and Risks Both high blood pressure and low pulse can cause specific complications. High blood pressure can cause or contribute to the following conditions: Stroke Heart failure Heart attack Aneurysm Aortic dissection, or a tear in the wall of your blood vessel Kidney disease Eye problems Severely low pulse can cause the following complications: Fainting Frequent falls that may cause injury Heart failure Cardiac arrest How To Prevent High Blood Pressure and Low Pulse The best way to prevent high blood pressure and low pulse is to live a heart-healthy lifestyle and treat other underlying conditions that may be contributing to your symptoms. 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) When to Contact a Healthcare Provider 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. A Quick Review 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. Edited by Sukhman Rekhi Sukhman Rekhi Sukhman is a former editor at Health. learn more Was this page helpful? Thanks for your feedback! Tell us why! Other Submit 9 Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Heart Association. High blood pressure. Centers for Disease Control and Prevention. Facts about hypertension. American Heart Association. Bradycardia: Slow heart rate. Choudhury M, Kumar N, Chalil S, Abozguia K. Refractory hypertensive emergency associated with complete heart block resolved after permanent pacemaker implantation: A case report. Clin Case Rep. 2022;10(6):e5964. doi:10.1002/ccr3.5964 Myrmel GMS, Ali A, Lunde T, Mancia G, Saeed S. An Unexpected Cause of Severe Hypertension and Bradycardia: The Role of Hemodynamic Assessment by Echocardiography. Pulse (Basel). 2022 Jun 14;10(1-4):46-51. doi:10.1159/000525078. Yumoto T, Mitsuhashi T, Yamakawa Y, et al. Impact of Cushing's sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):147. doi:10.1186/s13049-016-0341-1 American Heart Association. Changes you can make to manage high blood pressure. National Heart, Lung, and Blood Institute. High blood pressure: symptoms. American Heart Association. Life's Essential Eight.