systolic blood pressure and heart rate (beats)

[greenwellg]

It's been very hot and humid here in eastern Virginia. I love to play pickleball and try to play every day for 2 hours or more a day. I never worried about my blood pressure but found after some very strenuous games my mind was getting foggy and balance got worse. I took my blood pressure cuff that works on the left wrist and measured my pressure after a hard fought game. Systolic 250 Diastolic 110 but the crazy thing was my pulse rate was only 73. Most of what you search on the internet is how to lower your blood pressure. Mine needed to go up. Once recommendation was coffee so I drank some. That helped but something worked for me that was not supposed to and that was cold water headband and towel around the throat. I figured it out by using a towel to almost freeze in cold water, then wring it out and basically put it over my already sweaty t shirt as well as wipe off my arms and place it on my chest for a while and on top of my head.
This morning when I first started playing I had no cold water rags on me and the Systolic hit 250/110/100 heartbeat. It took 11 minutes to get it back to my normal 120/80/80 or lower heartbeat using the cooling headband and towel around my neck. Next game I wore the cold headband and towel while playing (both soaked in ice water). My heartbeat stayed high (where I wanted it) between 94 and 110 but the Systolic and Diastolic reading were lower with the Systolic being 75 to 100 points lower (Systolic) with the higher heart rate.
My game was so much better as well as my thinking and reaction times and the way I felt when a hard fought game was over was orders of magnitude better than before.
Now I will pre-apply the ice water towels and see if I can end the time when Excess Systolic pressure was ruining my game.
I'll be 75 in 4 months and very few people my age play pickleball. I'd bet that many here use cold towels to stay cool when working in serious heat and humidity, but if you don't, It's definitely worth trying. I just had my first cat scan with dye in the veins to highlight any problems. In my case it was a previously diagnosed thoracic ascending aortic aneurysm which can be deadly if failure is catastrophic. Basically you bleed out into the chest and it stops the lungs from exchanging air and you either pass out or suffocate in a couple of minutes, long before any help can arrive or anyone has the presence of mine to punch a hole (in your chest) and allow the blood to drain as a stopgap measure. The latest CT showed that the diameter was 4.0 CM versus the previously reported 4.3 CM was lower by a significant amount without the high blood pressure I always have when in any medical establishment compounding the diagnosis.

 

[Outpost75]

With systolic BP 250 at stress you should followup with your cardiologist. Eleven minutes recovery to normal BP does not sound good.

I am not a physician but a 76 year old patient recovering from heart failure with Afib, Bradycardia with premature ventricular contractions and reduced ejection fraction of 45%. My resting pulse rate is in the 40s and barely gets over 80 on the treadmill before I get dizzy.

Still trying to get my meds worked out. Wearing a Holter monitor this week to evaluate whether an atropine infusion will do or if I need a pacemaker. Wish I could play pickleball, but two bad knees. Bicycle and walking are my therapy.

 

[GnarlsR2]

If I was diagnosed with an ascending aortic aneurysm, I'd immediately switch from pickle ball to about 1 hour of muzzle flip.

 

[greenwellg]

Just saw the cardiologist after a CT scan with dye. Nothing wrong with the heart, could last 30 more years like POP. The BP is the problem and I think this is the solution. Perfect combination of exercise and movement. Pop had a trans catheter aortic valve replacement at 98. Lived to 103 and passed due to chronic pneumonia.

 

[Greyman50]

Saw my cardio. PA the other day, told me I had a better heart everything than some people shes seen half my age( 74) so thank God.

 

[jpage]

An elevated BP and Heart-Rate during exercise will cause Your Thoracic-Aneurism to fail, likely causing immediate death. Probably a good idea to keep your Heart-Rate under 100 and Your BP under 120/80, until You can consult Your Physician.

 

[TIMETRIPPER]

Have you considered the possibility that your wrist cuff may be giving you false reads?

John

 

[gjgalligan]

At 250 I would be calling for EMS....

 

[Onomea]

Greenwellg, you seem remarkably fit, but to 73 YO me with an enlarged ascending aorta that my cardiologist keeps an eye on, your situation sounded worrisome.

So I fed your post into ChatGPT — an AI chatbox — and asked for comments. Here's what it said:

This person's post raises serious health concerns that should not be taken lightly. Let's break it down:

Key Concerns

1. Blood Pressure of 250/110 mmHg

• This is dangerously high—hypertensive crisis territory.
• Normal is under 120/80.
• A systolic pressure of 250 can trigger stroke, heart attack, or aortic dissection—especially dangerous for someone with an ascending aortic aneurysm.

2. Confusion, Balance Problems, and Foggy Thinking

• Classic warning signs of reduced cerebral perfusion, possibly due to extreme BP fluctuations or poor regulation.
• These are not merely "game fatigue." They are medical red flags.

3. Cold Towels Lowering BP & Raising Pulse

• Cooling the body does help with thermoregulation, which can relieve stress on the cardiovascular system.
• The cold compresses may have helped bring blood pressure down indirectly by reducing heat stress and peripheral vasoconstriction—but this is not a medically adequate solution for severe hypertension.

4. Pulse of 73 with BP 250/110

• That's not a physiologically expected pairing.
• You'd expect an elevated pulse in this state. A low pulse with extreme hypertension could mean baroreceptor reflex is kicking in, or even conduction abnormalities or autonomic dysfunction.
• Could also suggest measurement error, especially with wrist cuffs (which are less accurate than upper-arm cuffs).

5. Thoracic Aortic Aneurysm

• This is a life-threatening condition when combined with:
  • Severe hypertension
  • Physical strain
  • Hot/humid weather
• Aneurysms can dissect or rupture—especially at high pressures.
• Playing strenuous pickleball in heat with known aortic aneurysm and BP spikes > 200 is reckless without strict clearance and supervision by a cardiologist.

Final Thoughts

This individual is:

• 74 years old
• Playing intense pickleball daily in hot, humid conditions
• Experiencing hypertensive crises
• Has a known ascending aortic aneurysm
• Using non-medical cooling strategies to mitigate what are essentially medical emergencies

What Should Be Done

1. Stop strenuous play immediately until cleared by a cardiologist or vascular surgeon.
2. Switch to a more accurate upper-arm BP cuff.
3. Get continuous ambulatory BP monitoring and cardiac evaluation (maybe a Holter or event monitor).
4. Strictly manage BP with medical guidance—cool towels may feel good, but are not treatment for a hypertensive crisis.
5. Discuss surgical thresholds and risks for the aneurysm (≥5.0 cm is often considered for elective repair, but 4.0–4.5 may warrant close surveillance and lifestyle limits).

In short:

This is not just an anecdote about heat and cooling towels—it's a medical warning sign. Someone with aortic disease experiencing BP of 250/110 needs more than hydration and cooling gear. They need a cardiology workup and lifestyle restrictions ASAP.

 

[SMSgt]

People who think they are in great shape with the exercise programs often drop dead from cardiac arrest. Your BP readings are off the charts. Get checked out!

 

[GnarlsR2]

Onomea..

Your post is extremely informative!

Thank you.

 

[greenwellg]

Appreciate all the advice, every bit. I had the scan for the aortic artery and contrast through an IV. I have the worst case of white coat syndrome most of the doctors have ever seen. I kept records of the pressure readings so my personal doctor could see what was going on AND the heart surgeon's office they could not even get a reading until I was ready to leave the office and then it was 207 systolic. I am going for another test on the 24th for another suspected anurism in the lower aortic artery and a consult with another surgeon. I have confirmed the accuracy of the cuff tester with readings at the fire station and at a hospital where I went 10 years ago for a similar event. The testing and consults as well as my personal physician are taken seriously but it's time to focus on the supper high pressure events and stop them in their tracks regardless of what is necessary including playing any sports and changing exercise routines to control any dangerous event. Even with these events the heart surgeon has said my heart was in good shape and I could get close to my fathers 103.5 years lifespan but as is posted here the systolic pressure is cataclysmic in long term lifespan expectancy. Pre cooling any exercise is essential and still requires close monitoring. Going to take a break from Pickleball for a few days until after the 24th testing.
The cooling kept the systolic below 150 and peak exertion and I now know what the difference feels like and the danger involved.
Again, thanks to every one of you and expecially those who did individual research to provide me with knowledge and the potential for this to put me in the ground or an urn.

 

[Golddollar]

At 250 I would be calling for EMS....

About 4 or 5 years ago I was sitting on the edge of my bed when I got a feeling like somebody slugged me upside the head. When I stood up my legs were wobbly. I stumbled out to the kitchen and hooked up my BP monitor. The top number was in the 190s and about 3 seconds later I was calling for an ambulance. There was just too much history of strokes in my family to take a chance.

 

[greenwellg]

My problem is not typical. It's like the heartbeat does not respond to stress (physical activity) but the Systolic pressure handles all of the differences in stress. For the first time I can remember I was sitting in my recliner at home and I felt dizzy. I checked the blood pressure (and the cuff has proven to be accurate, I trust the readings) and my heart rate was dead steady at 61 and the systolic jumped to 188! All mental no exercise induced stress.
It's fear simple as that.
Now I had a terrible injury in an auto accidents at half my present age, A head injury, knocked out cold, damn near burned alive while unconscious and saved by a person I never met (an angel) by being pulled from a burning car sitting on top of a parked car in an apartment parking lot.
Is that head injury a contributing factor?
I have dealt with chronic pain since that injury and found ways to mitigate the pain to the point where now I take over the counter pain meds to get a good night's sleep. None during the daytime and almost no headaches.
Yesterday I played pickleball for 3 hours with breaks between games 99% of my opponents are younger than myself, many decades younger and play very well winning a lot of the local tournaments so TOUGH competition. It takes everything I have to beat them, think of it as almost like combat. I do not want to stop that exercise and all of my doctors say it is an essential component of my future health. Both my GP and the heart doctor tell me to stay active to stay healthy.
Yesterday for the first time I got absolute proof of the effectiveness of additional cooling doing exactly what I wanted it to do, Heart rate increased by 50% (average 100) while systolic pressure dropped to around 150 (perfect). Everything worked better, my performance improved dramatically.
I KNOW this is the solution, proven by real evidence collection. 30 beats per minute higher heart rate 100 points per minute lower Systolic pressure.
I have the antithesis of AFIB my heart was beating faster with lower blood pressure. Not irregular or out of control but perfect for the conditions. One other player noted his heart rate was 170 during play. Mine has not been that high in decades. The only prescription medication I take is for cholestrol.
This is not meant to be argumentative in any regards. I have read every post and my memory is still very good. The heart doctors Physician's assistant listened to me very em-pathetically and told me my heart can last another 30 years, but controlling the systolic pressure is ESSENTIAL to longevity.
As Roosevelt said "the om;y thing we have to fear is fear itself" My anxiety is my greatest enemy and I have numerous instances of very poor medical care making things much worse than they were before. Not talking about anyone posting here. The pickleball players I see daily are doctors, nurses, first responders and they all tell me I need to call an ambulance when systolic goes that high anything over 180 is considered very serious. I have been to the fire station where readings were confirmed with my cuff, then to the hospital, spent a thousand bucks and nothing was done to lower the pressure except observation.
It's triggered by anger and anxiety. When I play my favorite game I want to kick yer arse. I just need the heart to beat more to succeed!!!!!!!!!!!!!!!

 

[Jon651]

Here are a few thoughts:

A blood pressure of 250/110 is dangerous. Period. Your chances of stroke or other serious issues are sky high enough I would cease all physical activity that causes that reading until I could do two things - verify the reading with another cuff (I would strongly recommend stopping by your local fire station as I have zero faith in consumer-grade B/P monitoring equipment sold at the local chain pharmacies), and call your doctor ASAP. Frankly anyone who walked into any of my old fire stations with those numbers - especially if they also mentioned feeling "fuzzy" or having ANY issues with cognition - would be enjoying an interior view of my rescue truck and a deluxe trip to the local ER (preferably one that was also a stroke center, just in case...).

Apparently if your heart rate does not compensate for increased physical activity then you have additional problems to worry about. At some point, someone is going to mention the word "pacemaker" to you... If your HR is actually THAT LOW yet your B/P is THAT HIGH then your body is compensating for issues that need to be addressed.

Here's some thumbnail physiology (this is a generalization only) - your body has two natural mechanisms for raising your blood pressure during physical activity. They are by raising your heart rate and/or making your blood vessels smaller. During your pickleball games when your B/P spikes, what it sounds like is that since your HR is not increasing then your body is clamping down the vessels to give you the blood pressure it thinks you need in that moment. It appears that the external cooling is helping to relax the blood vessels and provide more blood flow which makes you feel better. Any positive results you may get from external cooling are only a stop-gap measure and certainly NOT an actual fix for your issues. At best you are buying a little time before things get worse - and they always seem to get worse.

As an aside, somewhere in this thread I read the words "Ascending Aortic Aneurysm" - this is a critical condition that needs to be addressed YESTERDAY. As a retired paramedic, if we diagnosed a "Triple-A" in the field I would not even allow my patient to rise or stand under their own power - they would remain lying on their back strapped down to a backboard and my stretcher until we arrived at the ER, where we would promptly confirm the diagnosis via ultrasound then run/don't walk to the surgical suite. Yes, it's that critical. No, I don't think you have this based on what you report (or if you do it's not a factor in this).

And lastly, while I've put in my two cents worth from the perspective of a 30-year retired paramedic, this is NOT the place for medical advice of any sort. Oh, and neither is ChatGPT or any other AI program. If attorney's are slowing learning (the hard way) not to let AI write their briefs or other legal documents then is it an order of magnitude worse to substitute AI for an actual doctor. And that is my only advice here - go to your doctor. Oh, and don't expect either a one-visit diagnosis or a one-visit fix - that only happens on TV.

 

[rockquarry]

I always contact my cardiologist or at least my family doctor with these concerns. I trust their judgement more than I would an Internet diagnosis from those with dubious medical credentials. But I know you all have good intentions...

 

[Onomea]

I like to use ChatGPT to get a handle on what may be going on. I think most people are well enough read to realize AI makes mistakes and is no substitute for a live doctor. (It is one helluva lot better than I am though at diagnosing what may be going on.)

I particularly like it for explaining to me in layman's terms what the results of medical tests mean prior to getting the opportunity to discuss the results with a doctor.

More to the point for this forum, it is also handy on firearms stuff, e.g., comparing the specs of different models or finding out who has what models in stock. ( ChatGPT did make an error on magazine compatibility yesterday though, so you do need to keep an eye on it.)

AI is a useful assist, an augmentation, to critical, creative thinking. It is not a replacement.

 

[jaydoc]

Point 1
A systolic BP of 250 is NOT white coat hypertension. It is malignant hypertension!
Point 2
Most of what you have told us is pretty concerning. If the facts are correct and your Dr says you'll probably live to be 103, like dad or grandpa or whoever, you are either choosing not to hear what he is really saying, or he is an idiot.
Point 3
You seem to be very confident that you're doing fine. You will probably keep thinking this way until you drop dead suddenly from a catastrophic vascular event.
But what do I know? You seem to know it all so I'm really not sure why you even started this thread.
I'll show myself out.
Wish you well, sir

 

[greenwellg]

Stayed home today no activity just relaxing in my recliner.
143 70 70 morning
129 71 70
130 70 72
136 72 68
122 79 65 afternoon
136 78 66
115 79 64
130 77 65
One doctor in Marathon, Fla Keys actually told me to stay for a while while he ate lunch. WE talked about my job, cars and it took about 10-15 minutes when these readings were what he saw. Watching him eat a bag lunch calmed me down. He told me the only problem I had was I didn't like Doctors. I told him I'll bet you feel the same way when your car is towed to the mechanic. 40 years ago.

 

[Rustyt1953]