Exercising with High Blood Pressure

Original Post by David Berkson, M.D.

High blood pressure, or hypertension, is one of the most common medical problems—affecting about one quarter of all Americans. It is also the most common cardiovascular condition in competitive athletes.

Blood pressure can be thought of as looking at the stress on the heart. The top number is known as the systolic pressure and measures the stress when the heart is actively beating. The bottom number is called the diastolic pressure which measures the stress when the heart is at rest, between beats. The greater the stress on the heart, the greater the risk of strokes, heart attacks, and heart failure.

In adults, normal blood pressure is less than 120/80. Blood pressure between 120-139/80-89 is considered pre-hypertension, which puts someone at an increased risk of developing hypertension in their future. Stage 1 hypertension is when the blood pressure is between 140-159/90-99. Stage 2 is over 160/100, which puts you at a 150-300% increased risk of having a stroke, heart attack, or heart failure.

So if you have high blood pressure, what can you do to get it down? Eating a healthy diet and exercising are a great start. But, depending on the height of your blood pressure, there may be certain exercises you should avoid until your blood pressure is under better control. In particular, anyone with stage 2 hypertension needs to have their blood pressure controlled before they start an exercise program. Your doctor can discuss these issues with you in detail.

Cutting out foods and drugs that can raise blood pressure will help also. Caffeine, alcohol, and tobacco are common agents that elevate the blood pressure, as are certain over-the-counter medications like decongestants and appetite suppressants.

While lifestyle modifications are great for your overall health, they may only help to lower the blood pressure by about 10 points, which may not be enough. Often time medication is needed to fully control the blood pressure. Many options for medications exist, but some of them are better than others for athletes.

Medications preferred by many athletes are those that do not affect exercise tolerance and heart rate response to exercise. ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) both are very well tolerated and are the least likely to cause any problems with exercise.

Medications like Beta blockers and Calcium Channel blockers, while excellent medications to help control blood pressure, can decrease the heart rate and also possibly affect exercise tolerance and are typically not used as first line agents for treatment of blood pressure in athletes.

Elite athletes who participate in events sanctioned by national or international governing bodies need to make sure any medication they take is not part of the banned substances list for their sport.

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Original Post by David Berkson, M.D.