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High BP but Low pulse rate
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High BP but Low pulse rate

My husband was recently at the doctors and was told that he has high blood pressure.  She didn't tell him exactly the reading but said it was higher than 140/90.  She also took his resting pulse and said that it was the lowest she had ever seen in her office and it was 49 bpm.  She was surprised at his high BP and couldn't explain how his BP could be high yet his pulse be so low.  Over the past few months he has experienced multiple nose bleeds, dialated or burst blood vessels in the whites of his eyes, and occasional bouts of light headedness when standing from a seated position. He is also chronically exhausted despite getting 8 hrs of sleep a night plus a daily 1 hr nap.

My husband is 29 and an elite athlete (rower) who trains 3-4 hours a day.  He is 5'10", 160 lbs and in excellent shape.  He eats very well and lives a fairly non-stressful life.  There is no history of heart disease in his family.  He takes Effexor-XR once a day but was told that high BP is not one of the possible side effects.  

How is it that he can be so fit and have such a low pulse yet have high blood pressure?  What could be causing his high BP?  Is his high BP causing his fatigue and other symptoms?

I appreciate any insite you may have.
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74076_tn?1189759432
Hello,

These are tough situations to know for sure.  First of all, if your husbands  heart rate increases with exercise to an appropriate level (in his case, probably greater than 140-160) with strenuous exercise, his heart rate is fine.  Athletes have slow heart rates because of increased vagal tone associated with fitness.  This is a good thing.

Second, being fit does not by any means mean that you cannothave hypertension. The most common cause of hypertension is essential hypertension -- we have no idea what causes it and it should be controlled with diet and exercise first, then if that fails, then medications.  Athletes usually can't do much more with diet and exercse and require medications.  How think of this is a matter of perspective. The problemi isn't that he has hypertension, the problem is it isn't controlled. Know about it and treating it appropriately is the soluation.  I wouldn't get too worked up about the diagnosis, I would just make sure it is controlled.

buy a  blood pressure cuff, validate it by checking it in your doctors office while they check it at  the same time and then keep track of it home.  

I would see a hypertension speicalist.  While 98% of people his age have essential hypertension, the other 2% can be over looked. See someone that deals with this problem often and make sure there isn't other reason.  Depression can increase blood pressure and cause fatigue.  That is one possibility.  It depends on how high the pressure is though.  I would see a specialist.  High blood pressure in a young person is almost always asymptomatic unless it is VERY high. I doubt it is causing fatigue, but again, see a hypertension specialist to make sure.  He is young and the cummulative damage to the arteries over the next 50 years if this isn't controlled could be significant.

I hope this helps.  Good luck and thanks for posting.
16 Comments
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84483_tn?1289941537
This is a great question. I know a couple of persons with low pulse rates 45-50 and B/P over 140/90 with no other risks factors for CAD besides being male.
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Avatar_n_tn
I wonder if it's some sort of overshoot by the autonomic nervous system?  Perhaps a very low pulse is perceived as a risk for hypotension, so the vascular beds clamp down to bring the pressure up, but it goes too far in some people.  I dunno; it happens to me, too:  If my pulse gets into the low fifties, I'll often have quite high pressures at the time.
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Avatar_n_tn
I have been told by a Doctor that very fit people often have low heart rate. Champion tennis players around 40 beats per min.
I can not reconcile his training regime chronic exhaustion.
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Avatar_m_tn
I have also been afflicted with high BP moreso systolic (150-180)/70-90 but this occurs in the early morning or as soon as I awake and within 15 minutes it could be 130/70. My pulse could be in the 50-60 range with the high BP and elevate to 60-70 as the BP normalizes. I have tried switching my BP med - Diovan to the evening hours but with little effect. I have been labelled a non-dipper BP type by my GP but besides warning about long term kidney damage/disease he seems baffled and does not know what to prescribe for this. I have been Dx with mild to moderate sleep apnea and wonder whether this could be the cause? Appreciate comments from anyone.
ChrisR.
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Avatar_n_tn
Have you goggled effexor-xr? There are some links that report high blood pressure as a less common side effect but that does mean that some have reported it. Is there any possibilty that they could switch him to something else to see if that is the cause before they add another drug for hbp to his list.

Just a thought and only my opinion. I have also read and heard that people who are very athletic etc.,  can have these low heart rates.

I hope you get the answers you are looking for :)

http://en.wikipedia.org/wiki/Effexor  Just one little link about effexor for your info.
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Avatar_n_tn
I am surprised a doc hasnt answered this question yet. Low heart rate is excellent, it is seen in most athletes. I am 34 and in perfect shape, muscle/bodyweight.  What I found out later on is that I was actually alergic (allergic) to alcohol which included extremely high B/P on two occasions where I had to be hospitilazed (around 240/160)  The nursed couldnt believe that someone that looked like me had this problem and they actually got two different machines to check the BP.  While at the hospital which was at Redlands, CA  I was seen by one of the foremost cardio guys in the world ( he made the first baboon to child transplant)  and I was told by him that the BP could spike to extremes especially if the person is excitable.  While I was there I spoke with quite a few people ( staying in bed all day sux)  I spoke with some brain tumor patients and they said the first sign was a nose bleed so... Please have him get an MRI
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74076_tn?1189759432
I forgot to mention, Effexor has stimulant properties and can cause hypertension and orthostatic hypotension (Lightheadedness iwth standing).  If the hypertension is mild it may be worth switching angents first, if blood pressure is very high this is unlikely the cause.
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Avatar_n_tn
Hi,

Just a quick thought, has he been checked for pheochromoctyoma?  It is an adrenal gland tumor that causes very high blood pressure for seemingly no reason.  That was just the first thing that popped into my head when I read your post.  They can check for it either with cat scan or 24 hour urinary catacholamines and metanephrines.  I'm not a doctor, obviously, but it could be one thing to rule out.  Good luck to him though (:
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Avatar_f_tn
People can have extremely high BP and no symptoms whatsoever except for anxiety as it was in my case.  I was three times in the ER with a BP of 255/160.  I had no headache, no dizziness, no tightness in the chest, no shortness of breath, and a pulse of 65, and was on no meds including BP meds.  My resting pulse without high BP is 50.  I've been exercising for many yrs and am in great shape, my pulse was/is always low.  The reason my BP was so high was due to severe anxiety. I had all the tests, the one to find a pheo, the 24 hour kidney test, EKG, echo, and a TEE test, all normal except for a mild leakage of my mitral valve.  Am on BP meds now because Cardiologist thinks that my BP must've been high at home for it to spike that high due to anxiety.  But at the same time told me that when under severe anxiety or anger all the BP meds you are taking will NOT help you at these moments, they are to keep my BP under control on a daily basis, but if severe anxiety sets in even the BP meds will not manage to keep my BP at a normal level.  That was exciting and comforting news.
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Avatar_n_tn
Did you have the sleep study?  My doctor wants me to have this but the only thing my health insurance will not pay for is a "sleep study".  

When I start dozing off, my HR starts going thru the roof and my breathing becomes affected.  He feels I need one of those machines.   I will have this study in 3 months when we switch insurances.
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Avatar_f_tn
My husband has sleep apnea.  We'd have never known, but he used to be fatigue a lot especially already in the mornings after he got up.  All tests came out negative, but the Cardiologist suggested sleep apnea.  He ordered for my husband to have this sleep test, and they found out that he stopped breathing many times (forgot how many) during the night while asleep, and they diagnosed it as COPD. He has to wear this mask at night.  The Cardiologist said that when people stop breathing its an extra load on your heart and blood pressure.  The machine also eliminates the snoring, which my husband was terrible with.  He says that he sleeps a lot better now, and I'm too for the snoring, and sometimes when I was awake I heard him stop breathing and that scared the hell out of me.
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Avatar_n_tn
I read every comment and was pleased to see the last one. Sleep apnea is a common cause of essential hypertension. I have had it to my knowledge since I was 19. CPAP treatment lowered my blood pressure to normal range without medication.
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Avatar_n_tn
I too am reading all of this.  I suspect I have this but my insurance vetoed the test.  I have new insurance coming soon and will get the study then. Thanks for the comments.
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Avatar_n_tn
Dear Everybody;
    
    I am a track and field champ, i practice 6 days a week,my nutrition is very good and i am 17 years old.

    recently i started to feel some shivering in my hands(like when drinking water from a cup), in addition to shortness of breath, lack of concentration, high pulse which taks long time to cool, and wounds taking too much time to heal, this have really affected my study and practice both physically and psychologically as i never had those symptomes before, and at the moment i am not taking any medication with a clean health record(didnt have any diseas or allergies).

PLEASE HELP or atleast tell me what type of doctor should i see because i am getting to be devistated by what is happening with me.

Thank You;
Ali Salhi
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