Discussion: BP Medicine and Intensity

High Blood Pressure will probably force me onto some pills very soon. I have done some reading and it looks like any kind of intense effort (running or otherwise) will be out-of-the-question. Diuretics will mean chronic dehydration. The various inhibitors will prevent my heart from pumping harder.

One of my goals is to do at least one ultra in the summer.

Any suggestions or experience? (don't say lose weight or eat better...already done. didn't help much).
thanks...frankj

We've got at least one person here on AttackPoint who is on meds for circulatory issues who still manages to do some pretty serious exercise (although I don't think you'll catch him doing an ultra in the summer). Any advice for this guy, you fishhead?

Huh? you talking 'bout me??

First off, I'm assuming you've been checked over for cardiac issues and this is based upon the assumption that your doctor has given you the OK to exercise. The following does not constitute medical advice, just a reflection on one particular case (mine).

I had an angioplasty and stent in spring of 2000. (BTW - I'm reasonably fit, good weight, don't smoke, decent diet etc - but some of us are just doomed to deal with this crap anyway)

Anyway, I'm on ace inhibitor, calcium channel blocker and beta blocker at this point and its keeping my BP in good shape (been on the current combo for about 4 years). Early on I was on a diuretic, but its effect was only short term, so I'm off it now. Doesn't affect the ability to exercise at a pretty decent level. I can still run at a hard intensity when I need to (hard enough for a Gold Medal in M45 at US Sprint Champs), but the heart rate is definitely limited by the meds - so you can't use a HRM and standard calculations for effort. You need to base your running on percieved effort. Since I'm on a 24 hour release dosing, I find there is a difference in HR for a percieved effort (like as hard as I can) at different times of the day. There's just no fixed HR target when you're on these things.

For longer distance efforts including ultras, you're not running at high intensities anyway so its a non-issue. I completed the Valley Forge Marathon (47.5km) comfortably in 6 hours last weekend with no specific training other than a 22 mile test run before thanksgiving. Sure, training may have allowed me to 'race' it a little more aggressively, but not by much.

Anyway, the meds will serve as sort of a governor on your cardiac output - so you may not be able to train and race at your maximal genetic capability, but you can certainly still train and race at a pretty high level (other diagnostic issues not withstanding).

So if the meds are strictly for reducing a higher than normal blood pressure, and not to counter other issues, then there is no reason you can't train yourself to continue competing if your doctor gives you the OK.

If you want to discuss any of this in more detail, feel free to email me privately...

PS - When I had my angio in 2000 my EKG and regular stress test were normal, even though I had a 90%+ blockage of the LAD. It was only when I had a nuclear stress test that the problem became apparent. So if you have any symptoms of cardiac issues and a regular EKG comes up normal make sure you get a second opinion from a doctor who understands cardiac issues in athletes or persons of otherwise good fitness. The majority of the medical establishment is trained to identify cardiac issues in older sedentary adults, but cardiac issues are harder to detect in otherwise healthy, fit persons and easily missed. Off my soapbox now...

mr. morse, thanks very much for that outline. i have no symptoms of anything except elevated BP (varies from the 120/7n range to 145/7n daily). so going on meds is seen as reducing a risk factor. i was mostly worried about how i might perform in the heat. i really don't compete at a very intensive effort, and i'm ok with that. but i never want to fall down with heat stroke either.

It doesn't sound as bad as I thought tho, I think I will go see a sports doctor for a second opinion.

thanks...frankj

frankj, here's another input. Again just personal experience not medical advice. etc. But I've been on a diuretic for marginally high BP for several years now and chronic dehydration has never been an issue for me. When I'm training a lot I drink a lot of water and everything seems pretty normal. I'm able to train hard and race hard when I want to, including cross-country ski marathons, with no trouble. On days that I know I'm going to sweat off a lot of water I sometimes skip taking the medication. This was with my doctor's ok of course. I guess I never did all the reading, so I don't know enough to be worried about whatever it is you were reading. :-) I seem to be capable of cranking up the intensity when I want to though. I would definitely endorse talking to a doctor and asking all the questions you can think of. I was never warned to limit my exercise. My doctor endorsed the idea of getting good exercise saying it could only help. Do let us know what you find out. There are quite likely several others around here on diuretics with similar stories.

frankj, I'm not sure you should dismiss diet changes so quickly.

I was diagnosed with elevated blood pressure (150/90) 30 years ago, when I was in my late 30's. Doc then gave me a routine treadmill stress test and wanted to put me on pills, but relented when I promised to mend my ways.

At the time, Jim Fixx had just died an early death, and Nathan Pritiken was preaching the benefits of a low fat (total calories from fat < 5%) diet for treating hypertension. While I never attained that low level, I did make major changes in my diet, which had been the typical American diet (fat > 40% of total calories). And altho it took more than a decade, my BP started to come down...last month it was measured at 120/65.

Now that I'm approaching 70 I'm aware that there may be other dietary concerns than just fat. I was very influenced by a lengthy NYTimes article last January about the American diet entitled Unhappy Meals. Author Michael Pollan claimed that the reason civilized man always ate so much carbohydrate was only for merchantile reasons: grain could be easily stored and traded, which fresh food, such as spinach could not. But a grain-centered diet is not good for you: are you a steer out on a Colorado feed lot being fattened for slaughter? I believe Dr Barry Sears' Zone Diet probably comes closest to answering Pollan's concerns.

So I've begun to regard all food as a drug. And recently my diet has been mainly leaves and canned salmon. No sugars, no carbohydrates, limited fats. Not the most thrilling diet. But I feel much better. And my doc says my health recently has improved markedly...in ways that only another old guy could appreciate.

Sometimes I'm pretty sure I read too much! Endurance/BP med related studies are not as common as I would like them to be. This statement piques my interest: "... I sometimes skip taking the medication". I will definitely seek my doctor's advice on that. If sweating has the same result as a diuretic (which I'm not sure it does), then I'm OK. And my diet could be tidied up a bit. I eat a lot of carb. about 15% fat. 20 to 25% protein. Mostly grain (low glycemic).

Thanks to all for the anecdotal experiences. It certainly gives me a brighter picture of my future.
...frankj

Clark, thanks for the NY Times article link. & the rest. Leaves & canned salmon. (I ate a cinnamon roll & drank coffee as I read your post.)

Well, I fall off the wagon plenty...

But as I learned trying to follow Pritiken, a half-hearted effort will still achieve great things.

regular easy runs works very well for lowering BP for at least 24 hours period after run, also eliminating stress and getting enough sleep are essential to keep it in norm.
had very bad expierens with doctors, they tried to put me on diuretics, with no other options, which i dropped after couple weeks due to unpleasant side effects with no sizable change in BP.
what should be avoided - alcohol, long hours behind computer. didn't notice big caffeine impact on BP, at least from moderate amount of coffee.

I have been taking high bp tablets as prescribed by the dr (avapro) for about a year now and wasnt aware of any running related side effects/issues. The only thing i have heard but not noticed is that they can make your muscles more prone to tears etc so you might need to be more careful warming up.

Well, I guess my Dr.'s scare tactic is working. BP is way down. Best in the past month was 115/75. What'd I do? Eat a little less. No subs at all. Drank 6 to 8 bottles of water every day. Only slipped and ate poorly one day. Worked out tons. Going on "div's" suggestion about easy runs, I have made cardio an everyday occurance. The combination seems to affect BP in a very positive way. I hope it's positive enough when I go see my doc in January.