High Blood Pressure

Originally Posted by rjdirgo

I found that if you exercise on the treadmill walking briskly or running 2-3 times a week in addtion to cycling, it helps to keep your blood pressure under control. In Covert Bailey's Smart Exercise book he says that the trick is in engaging more muscles in your exercise which results in more capillaries to dilate. If the blood has more room to travel in your body your blood pressure goes down. The trouble with cycling is it uses less muscles than walking or running and thus reducing capillary dilation. I think if you cross train, using the treadmill for jogging/walking briskly in addtion to cycling this mix will result in overall a lower of your blood pressure.

Originally Posted by nerdag

There's at least seven different categories...

cholinergics, diuretics, beta-blockers, calcium channel inhibitors, angiotensin II receptor blockers, ACE inhibitors, centrally acting medications.

All have different effects, and all will affect your cycling performance in different ways.

I would suggest an AT2R blocker, or an ACE inhibitor if you're wanting to minimise the effect on strenuous aerobic efforts. These inhibit primary the physiological mechanism that increases blood pressure, and doesn't slow down your HR or affect your peripheral circulation. They do have some other side effects, which you may or may not experience and may or may not be able to cope with. Most people tolerate AT2RBs and ACE inhibitors quite well.

If your cholesterol is high as well, you might benefit from being on a statin in addition to your BP meds.

HTH,

nerdag

Originally Posted by RickF

This is the best post so far. I would stay away from hawthorn tea and other "natural" or "herbal" remedies. There are two major problems with these. The first is that they have never been put through rigorous testing to determine if they work. The second is even more serious, and that is that there are no standards to ensure uniformity from batch to batch, from year to year, or from growing location to growing location. Everyone recognizes that wine from California can taste entirely different from wine made from the same grape variety grown in France or Italy. Everyone also recognizes that wine from grapes grown in one year does not taste exactly the same as wine made from the same grapes grown in the same location in a different year. The same is true of any botanical product. Where it is grown and when it is grown will affect the composition of the product. Also, remember that just because it is "natural" does not make it safe. Hemlock, bitter almond, and cobra venom are "natural" - deadly, but "natural".

I have been hypertensive since I was 16 years old. My blood pressure was just as high when I was 25 years old and weighed 175 pounds as it was when I was 50 years old and weighed 260 pounds. I take lisinopril (an ACE inhibitor) and hydrochlorothiazide (a diuretic), and my blood pressure is well controlled.

An ACE inhibitor (or AT2R blocker) or a diuretic is the best thing to try first. If one agent alone does not control blood pressure, then add the other. These would be the least likely to affect exercise and training abililty, and are the ones that show the most benefit in terms of long term outcome (preventing stroke, renal failure, and heart attacks). Prevention of the long term effects is the reason that blood pressure should be treated. The one potential problem with most of the diuretics is hypokalemia (low concentrations of potassium in the blood). This usually can be prevented by eating fruits, especially bananas and apricots, but some people do require potassium chloride supplements. Hypokalemia will have a negative impact on exercise and training ability.

Beta blockers also have been shown to prevent the long term effects of hypertension, but beta blockers do not allow the heart to speed up in response to stress or exercise. While this is a good thing if you are trying to reduce the workload of the heart and reduce blood pressure, it will have a negative impact on exercise and training ability. Some beta blockers are especially useful in preventing heart failure in patients who have already had a heart attack and in treating heart failure, but the real goal is to prevent these problems in the first place. Beta blockers are not a good choice in patients who have asthma or chronic obstructive pulmonary disease (COPD - emphysema), because they can constrict the airways. This action, too, could cause a negative impact on exercise or training ability.

Calcium channel blockers should be reserved for patients who do not respond enough to the other agents. Head to head studies of calcium channel blockers and ACE inhibitors show that even though calcium channel blockers lower blood pressure better, ACE inhibitors are better at preventing the long term problems associated with high blood pressure. AT2R blockers are similar to ACE inhibitors in their effect, although they attack the problem from different sides. AT2R blockers block the effect of angiotensin II at the receptor. ACE inhibitors prevent the formation of angiotensin II. Even though AT2R blockers and ACE inhibitors should provide the same benefits (and most available data support this), there are far more data available on ACE inhibitors then there are on AT2R blockers.

Vasodilators are not used much now that the ACE inhibitors and AT2R blockers are available. Vasodilators do lower blood pressure, but they can increase the workload on the heart, and they can lead to some unpleasant and potentially dangerous side effects, particularly orthostatic hypotension (rapid fall in blood pressure upon standing). Orthostatic hypotension can be severe enough that people pass out when they stand up quickly. Vasodilators are still useful, though, in some patients in combination with other agents when ACE inhibitors (or AT2R blockers), diuretics, and beta blockers do not lower blood pressure adequately.

Originally Posted by rippitupp

i would not recommend the diuretic approach to an athlete, or cyclist. Hydration is very important for endurance sports, and a diuretic basically dehydrates you, which lowers your preload, and in turn your Cardiac Output and blood pressure
Vasodilators is a very vague classification of drug...infact most of the drugs you mentioned are vasodilators.....Beta blockers, calcium channell blockers, ACE inhibitors....just the mechanism of action differs.
i think the best choice is not to look for an answer on such an important health matter on this forum...find an internist, on who will listen to what your lifestyle and goals are, and taylor a treatment plan suited for only you...

Originally Posted by RickF

By vasodialator, I was refering to the direct vasodialators, like hydralazine. ACE inhibitors, ARBs, and beta blockers block mechanisms of vasoconstriction, but that is not the same as a direct vasodilator. The direct vasodilators drop the diastolic pressure, but they have very little effect on systolic pressure.

At the dose of thiazide diuretics that are used today (e.g., 12.5 mg of hydrochlorothiazide), there is no effect on hydration status or preload, but a major effect on blood pressure, especially when combined with an ACE inhibitor or ARB. The antihypertensive effect of the thiazide diuretics is not due to volume contraction and decreased preload. Loop diuretics (furosamide, et. al.) are a different matter, and I would agree that loop diuretics are not appropriate for athletes.