Triathlon Training with High Blood Pressure

author : AMSSM

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Elevated blood pressure is the most common cardiovascular disease in the United States. There are many things to consider in the recommendation of training for individuals with high blood pressure.

By Benjamin Moorehead, MD
WVU Department of Orthopaedics
Member AMSSM

Hypertension, or elevated blood pressure, is the most common cardiovascular disease in the United States affecting over 50 million people.  There are many things to consider in the recommendation of training for individuals with high blood pressure. 

However, probably the most important factor is the degree of blood pressure elevation. Blood pressure is given in two numbers.  The first number is the systolic pressure – think pressure with the heart pumping.  The second is the diastolic pressure – the pressure in the vessels when the heart is between beats.  Elevation in blood pressure can occur in one or both the systolic and diastolic numbers.

Normal blood pressure is defined as less than 120/80.
Pre-hypertension is 120-139 / 80-89
Stage 1 hypertension is 140-159 / 90-99
Stage 2 hypertension is > 160/100

Benefits of training with high blood pressure

Although blood pressure rises while exercising, exercising at a moderate intensity can help lower blood pressure at rest.  This effect is seen even in people with a normal blood pressure but this is more pronounced in people with hypertension.  Moderate intensity exercise should be at a level of 40-70% of VO2max.  Training at this level has been shown to reduce blood pressure the greatest, but higher intensity training is still acceptable and beneficial.

If your blood pressure is extremely elevated, your doctor may recommend limiting the intensity or amount of exercise.  While exercising (particularly with resistance training) there is a significant further increase in your blood pressure, putting you at a slight increased risk for a stroke.  This increased risk is very minimal, and generally the benefits of exercise outweigh those risks.  Once your blood pressure is controlled with medications you would be able to increase intensity again.

Beta blockers

Certain medications are better tolerated with exercise than others.  Beta blockers (such as metoprolol or carvedilol) will lower the maximal heart rate, so they may give you a sensation of fatigue while training by not allowing you to reach your target heart rate.  I would not recommend the use of a beta blocker while you are training, unless this is the only way to control your blood pressure. 

Diuretics

Care should be taken with diuretics, such as hydrochlorothiazide, as they may lead to dehydration, but exercise even of higher intensity is not contraindicated, so you can continue training and competing while using hydrochlorothiazide.

ACE inhibitors

ACE inhibitors such as Altace, or lisinopril are generally safe with exercise.  However, dehydration can lead to low blood pressure and dizziness.  So it is important to ensure adequate hydration.  It is very reasonable to continue training and competing while using an ACE inhibitor.   

Calcium channel blockers

Calcium channel blockers (CCBs) are another class of anti-hypertensives.  These work by blocking calcium channels in the arteries causing them to relax.  These are generally safe for triathletes to use, but some CCBs known as non-dihydropyidines act on the heart muscle and can slow the heart rate.  Again, it is reasonable to continue to train while using a CCB.

Although in most instances exercise including high intensity training and competition is acceptable and even beneficial to blood pressure, you should discuss the role of exercise and training with your physician to determine not only what level of training is safe for you, but also so that your physician can choose the best medications to effectively treat the hypertension without having a deleterious effect on your training.

Benjamin Moorehead, MD

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date: February 9, 2010