Hypertension and palpitations: what to know

Hypertension and palpitations can occur together, but a racing or pounding heartbeat is not usually caused by high blood pressure alone. Palpitations describe how your heartbeat feels; they do not identify the cause. A clinician may need to check your blood pressure, pulse rhythm, medicines and other possible triggers.

High blood pressure often causes no noticeable sensation. Palpitations may instead reflect a temporary increase in adrenaline, emotional stress, fever, dehydration, lack of sleep, caffeine, nicotine or some medicines. They can also occur with an abnormal heart rhythm, thyroid problems, anaemia or other heart conditions.

The two symptoms can still be related in some situations. Pain or anxiety can raise blood pressure while making the heartbeat feel more forceful. Some treatments, including decongestants and stimulant medicines, may affect both readings and heartbeat. Do not stop prescribed blood-pressure treatment without medical advice.

A home blood-pressure reading is useful but does not show whether the heartbeat is regular. During an assessment, a clinician may repeat readings after rest, examine you, review your medication and arrange an electrocardiogram or a longer rhythm monitor if the episodes come and go.

Sit quietly when palpitations begin and avoid driving if you feel faint. If possible, note when the episode started, how long it lasted, whether the rhythm felt regular or irregular, what you were doing, and any chest discomfort, breathlessness or dizziness.

Measure your blood pressure only after resting, with your back supported and your arm relaxed. Record the reading and pulse rather than repeatedly checking in alarm. Bring these notes, your medicines and any supplements to an appointment. Reduce personal triggers such as excess caffeine, nicotine and stimulant cold remedies, and keep hydrated unless you have been given fluid restrictions.

Arrange a routine review if palpitations recur, last longer than a brief episode, disturb sleep or occur with persistently raised readings. Your clinician can decide whether rhythm testing or checks for another medical cause are appropriate.

Seek emergency help immediately for palpitations with chest pain or pressure, severe breathlessness, fainting, new confusion, or marked weakness. Sudden facial drooping, trouble speaking, or weakness on one side may signal a stroke and also needs emergency care.

Do not wait for a home reading to improve when these warning signs are present. If the heartbeat remains very fast or irregular, or you feel light-headed and unwell, urgent assessment is appropriate. A severe headache with neurological symptoms, sudden vision change or collapse also warrants emergency help.

A symptom-free high reading still deserves timely medical advice, especially if readings remain high when repeated correctly. It is not possible to diagnose the cause of palpitations from blood pressure alone.

Ask whether your symptoms suggest a rhythm problem, whether any medicine or supplement could be contributing, and whether you need an electrocardiogram or ambulatory monitor. You can also ask how to measure blood pressure at home and what reading or symptom should prompt urgent contact.