# Correlation between pulse and blood pressure



## repm (Jun 26, 2011)

Hi to everyone!  I'm a brand spanking new EMT and I am very much in the learning process.

I had a call last night which I have a question about.

PT was a 65 y.o. female with a chief complaint of syncope.  She was having a heated discussion with her family when she collapsed.

Pertinent past HX includes hypertension, "cardiac murmur" (as reported by PT) and anxiety.

Meds include Lisinopril and Metoprolol.

When we arrived on scene, she was supine on the kitchen floor and alert and oriented.  SPO2 was 98% on room air. 

Pulse was 70, but her BP was 170/140, taken while she lying on the floor.

We sat her up and took her BP and this time it was 166/140.  Pulse was 72.

I was taken aback that her pulse was WNL, but her BP was so high.  I would expect that with a BP like that, that her pulse would also be high.  When I auscultated the BP, then saw the pulse rate, I started doubting my ears.

Would the meds skew the vitals?  Or is there no direct correlation between HBP and high pulse rate?

Thanks for any help with this and thanks for such a great sounding board here on EMTLife.  I've learned LOTS just lurking in the background.

P.S. - By the way, PT refused transport to the hospital.  Just wouldn't budge no matter how much we encouraged her.


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## LucidResq (Jun 26, 2011)

Just to dig in to your thinking here, what makes you think that a high-ish BP would lead to an elevated heart rate?


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## NomadicMedic (Jun 26, 2011)

Metoprolol, also known as Lopressor. What does it do? How does it work? That may help.


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## usalsfyre (Jun 26, 2011)

Multiple independent factors control each one. One doesn't always have a direct effect in the other (although I question a diastolic of 140 with a 26 point pulse pressure...how did you obtain the B/P?).


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## repm (Jun 26, 2011)

LucidResq said:


> Just to dig in to your thinking here, what makes you think that a high-ish BP would lead to an elevated heart rate?



Just seemed to make sense that an elevated BP would be followed by a faster pulse.  Nothing more than that.


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## repm (Jun 26, 2011)

usalsfyre said:


> Multiple independent factors control each one. One doesn't always have a direct effect in the other (although I question a diastolic of 140 with a 26 point pulse pressure...how did you obtain the B/P?).



Manually.


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## usalsfyre (Jun 26, 2011)

repm said:


> Just seemed to make sense that an elevated BP would be followed by a faster pulse.  Nothing more than that.



Read up on what controls blood pressure vs heart rate.

There are cases of extremely elevated B/P and extreme bradycardia (Cushing's Triad).


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## repm (Jun 26, 2011)

Thanks very much for all the reponses.  I'll get myself educated.


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## mike1390 (Jun 26, 2011)

Her meds are beta blockers so yea she would have a lower pulse rate. But high bp does not mean fast Pulse.


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## 8jimi8 (Jun 26, 2011)

The thought: high pulse /c concurrently high blood pressure isn't a logical conclusion to me.


It makes more sense that she would have a slower heart rate /c that high of a blood pressure.

From a hospital perspective 170mm/hg  is not that high.  I wouldn't even call the doctor for SBP < 180 mm/hg.  

Now then, I would treat it - most likely some hydralazine 10mg ivp.  OR labetalol 5-10 mg ivp.  (those are the two that we use in my ICU)

The goal is end organ perfusion and tissue oxygenation.  MAP needs to be maintained above 65 to ensure that the kidneys are receiving adequate blood flow.

The medications that you mentioned: one is for RATE control and the other is an ACE inhibitor.  

Look up beta blockers and see what hemodynamic functions will be effect from having beta 1 blocked.  

Then look up the difference between selective and non-selective beta-blockers and see what other organs could potentially be affected by this medication.

The lisinopril is also important for pressure control and another clue for you about this patient's history is the fact that she is on two cardiac medications.  That means that one drug isn't cutting it. 

A good question for the patient would be, what is your usual blood pressure at home and at the DR.'s office?

Also, does she check her pressure regularly?  When was the last time she took her meds and does she take them as prescribed?


As someone else mentioned, I would very much question a Diastolic BP that high and would have rechecked, or asked my partner to check it without telling him my results (independent double verification is the most reliable assessment)

Good for you, for thinking. Now its time for reading!


and possibly, you are not listening long enough if you are consistently hearing DBP >100 mm/hg.  when you get to the 140mm/hg diastolic you are entering a country known as Malignant Hypertension.  I would expect the patient to be on VERY large doses of 3 or more cardiac medications for such a condition.


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## 8jimi8 (Jun 26, 2011)

mike1390 said:


> Her meds are beta blockers so yea she would have a lower pulse rate. But high bp does not mean fast Pulse.



ONE of them is a beta blocker.


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## repm (Jun 26, 2011)

8jimi8 said:


> The thought: high pulse /c concurrently high blood pressure isn't a logical conclusion to me.
> 
> 
> It makes more sense that she would have a slower heart rate /c that high of a blood pressure.
> ...



Thanks very much for all the info.  As far as the diastolic number goes, there is NO doubt in this military mind that number was solid.  Initially, I pumped the cuff to about 160 and immediately heard the pulse.  The beat completely disappeared at 140 mm/HG.  I then retook the BP and that's when I got the 170 systolic number.  I did ask the paramedic to take the BP cause, as a newbie, I didn't trust my skills, but he said he trusted what I got.  

Thanks again.


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## 8jimi8 (Jun 26, 2011)

repm said:


> Thanks very much for all the info.  As far as the diastolic number goes, there is NO doubt in this military mind that number was solid.  Initially, I pumped the cuff to about 160 and immediately heard the pulse.  The beat completely disappeared at 140 mm/HG.  I then retook the BP and that's when I got the 170 systolic number.  I did ask the paramedic to take the BP cause, as a newbie, I didn't trust my skills, but he said he trusted what I got.
> 
> Thanks again.



For my personal practice, I always inflate the cuff to over 200.  and I listen LONG after i hear them disappear.  

The presentation doesn't correlate to a pulse pressure of 30 or less with pressure being that high, especially only being on 2 cardiac meds.  Seems like not enough information.

However, I wasn't there, I'm not armchairing you.


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## the_negro_puppy (Jun 26, 2011)

As others have said, BP doesn't necessarily correlate to HR.

Lets not forget that

Cardiac output = HR x Stroke volume

and BP = Cardiac output x Peripheral resistance.

Many disease pathologies and medications can alter the variables in these equations.

I wouldnt have trusted the BP either and retaken it or got my partner to do one.


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## MrBrown (Jun 26, 2011)

Brown agrees with everybody else.


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## EMTBHillbilly (Jun 28, 2011)

Think about what the body does when compensating for shock.
Now think about constricted vessels and how the body might react.  BP and HR do not move together in the same direction all the time.


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## Tigger (Jun 28, 2011)

Would finding a pulse pressure of 30 be a concern? Something to be noted of course, but if the patient presents as above, what would you be concerned about? 

If I remember correctly, a pulse pressure is considered to be too narrow if it is 25% of the systolic value. In this case that value is 42.5, so the pulse pressure (30) is quite a bit outside of these guidelines. 

So I guess the real question is whether or not this would be considered anything close to a life-threatening or altering illness. 

Regardless, is there anyway to treat this out of hospital?


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## MrBrown (Jun 29, 2011)

Brown would not be concerned and barely inclined to even recommend transport to the hospital.  We would call her status four (minor problem unlikely to change).

Did you actually auscultate for the presence of said "murmur"?


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