What Can Cause High Blood Pressure and a Low Pulse?

Medically Reviewed By Danielle Hildreth, CPT
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Having high blood pressure together with a low pulse is rare. However, it can be caused by several conditions and medications, including thickened heart tissue, Cushing reflex, and more. Your pulse rate is the number of times your heart beats in a minute. A pulse rate of fewer than 60 beats per minute (bpm) is considered too low. Experts refer to this as “bradycardia.”

Your blood pressure is the amount of force your circulating blood puts on your blood vessel walls. Experts refer to high blood pressure as hypertension.

Systolic blood pressure indicates the level of pressure while your heart contracts. A systolic blood pressure level below 130 is considered normal, while a level above 180 is considered critical.

Diastolic blood pressure refers to the pressure while your heart is relaxed. A diastolic blood pressure level below 80 is considered normal. Anything above 120 is critical.

Read on to learn what may cause high blood pressure with a low pulse. This article also discusses other symptoms you may notice, and what you should do.

Can you have high blood pressure and a low pulse? Is it dangerous?

there is a deflated heart shaped balloon
Juan Moyano/Stocksy United

A high pulse rate is often due to high blood pressure. However, this may change under certain circumstances.

Your heart acts as a pump, circulating blood around your body. The harder it squeezes, the higher the pressure on your vessels.

If your blood vessels have no blockages, blood flows easily. However, a buildup of plaque or narrowing of blood vessels creates resistance that your heart has to work against. This can lead to high blood pressure.

When your heart is working harder to pump blood, your heart rate typically increases. This causes high blood pressure together with a high pulse rate.

A high blood pressure with a low pulse rate may indicate a medical problem. This can include conditions such as an issue with your heart’s electrical system or thickened heart walls. Certain medications and traumatic injuries may also cause this condition.

Seek medical assistance if you have high blood pressure and a low pulse. It may be dangerous and is important to determine the underlying cause.

Learn more about what it means to have a slow heart rate.

Thickened heart tissue

Experts refer to thickened heart tissue as “cardiomyopathy.” This occurs when your heart muscle thickens, stiffens, or fills with bodily substances that do not belong in the heart muscle. This thickening makes it more difficult for your heart to pump blood effectively.

Cardiomyopathy can be genetic or develop over time due to disease or other factors. Often, the cause of the condition is unknown.

Cardiomyopathy may cause elevated blood pressure due to the extra effort required by your heart muscle. However, with this condition, your pulse rate may remain low.

Some people with cardiomyopathy may not display any symptoms. Those who do can experience:

  • shortness of breath
  • swelling in the lower legs or ankles
  • fatigue
  • irregular heartbeats
  • fainting

Treatment typically involves exercise and dietary changes, reducing stress, and medication. Severe cases may require surgery.

Learn about enlarged heart tissue.

Cushing reflex

Cushing reflex is a rare disorder due to high levels of pressure in the space around your brain. It occurs when the brain swells and presses against the inside of the skull. In response, the body attempts to prevent the brain from swelling too much. This can lead to:

  • high systolic pressure
  • low diastolic pressure
  • slow heart rate
  • irregular breathing

Several severe medical conditions may cause Cushing reflex, including:

Cushing reflux is a medical emergency that requires immediate treatment. The goal of treatment is to lower pressure inside the skull. Prognosis for this condition is often poor and may result in death.

Problems with heart conduction

Your heart has its own electrical system that controls the rate and rhythm of your heartbeat. Conduction disorders, or “heart block,” occur when these electrical signals stop working properly.

A low pulse rate may indicate a problem with your heart’s electrical system. Other symptoms may include:

Treatment will depend on the underlying cause. It may include attempting to repair the damaged area, taking medications, or implanting a pacemaker.

Blood pressure medications

Certain blood pressure medications such as beta-blockers may cause a low pulse rate. These can include:

  • metoprolol (Lopressor, Toprol XL)
  • atenolol (Tenormin)
  • nebivolol (Bystolic)
  • propranolol (Inderal)

These medications work by blocking beta receptors in the heart, which can lower the heart rate. This can be beneficial for people with high blood pressure, heart failure, or cardiac arrhythmias.

Because of how beta-blockers work, you may experience high blood pressure with a low pulse while taking these medications.

Learn more about high blood pressure medications.

Symptoms you might notice with high blood pressure and low pulse

High blood pressure with a low pulse may be accompanied by several other symptoms, including:

What to do with high blood pressure and a low pulse

If you take beta-blockers, you may experience slightly elevated blood pressure and a slower pulse. This is generally not a cause for concern when it occurs without other symptoms. However, if you experience these symptoms and are not taking medications that slow your heart rate, contact your doctor.

If you are experiencing symptoms such as confusion, chest pain, or difficulty breathing, seek emergency attention.

Learn when to see a doctor for high blood pressure.


High blood pressure with a low pulse rate may indicate an underlying medical condition. Treatment can be effective for some of these conditions, while others may require lifelong management.

If you have concerns about your blood pressure and heart rate, inform your medical professional. They can make an assessment and recommend appropriate treatment.

Frequently asked questions

Here are some frequently asked questions about high blood pressure and a low pulse.

What is a dangerously low heart rate?

The resting heart rate for adults should be between 60–100 bpm. However, certain people, such as athletes, may have slower heart rates.

Seek immediate medical attention if your heart rate is lower than 60 bpm and you feel lightheaded, confused, or weak.

Can a low pulse cause a stroke?

If your heart is not pumping enough blood to your brain, it may not be receiving enough oxygen. This can lead to a stroke.

What is stroke-level blood pressure?

A blood pressure level above 180/120 puts you at risk of a stroke. It is a medical emergency that requires immediate treatment.


Having high blood pressure with a low pulse is rare. It may indicate an underlying medical condition that requires treatment.

High blood pressure with a low pulse may be caused by medical conditions, such as thickened heart tissue or Cushing reflex. Beta-blocker medications can also cause a low heart rate with high blood pressure.

Seek immediate medical attention if you experience high blood pressure and a slow pulse along with lightheadedness, shortness of breath, or weakness.

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Medical Reviewer: Danielle Hildreth, CPT
Last Review Date: 2022 Nov 29
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