High blood pressure (in athletes)

[Susan]

DH had a health check at our doctor recently. They measured his blood pressure and it was quite high. They said this could have been related to being nervous because of the examination and told him they would measure it again in some weeks and would have to medicate him if it stays as high.

We borrowed a blood pressure monitor to measure his bp at home to see if his high numbers are related to being nervous at the doctor, but he measures at about 150 over 80 quite frequently even at home.

What bothers me is that he is at a normal weight, doesn't smoke, doesn't drink and does about one hour of sports daily, more on weekends. He's really an athlete. He should be healthy when I look at his lifestyle. We eat basically the same (my bp measurements are at about 100 over 60), a lot of vegetables, no sugar, mostly organic, real whole food cooked by myself.

The doctors seem not to be used to treating people that really live a healthy lifestyle and most of the tips we got regarding high bp seem to be targeted at unhealthy, not very active people.
I looked at the "DASH" eating plan that is designed to lower your blood pressure (http://www.nhlbi.nih.gov/health/publ...h/new_dash.pdf), but the plan really doesn't offer any improvements over our diet - we already do what this plan suggests and more. I will try to use even less salt (but it's not very appealing to eat food that tastes empty without salt to be honest).

I worry what will happen if DH can't lower his blood pressure. I'm not sure if the medication he will be put on will allow him to ride his bike and do sports as he did before. I'm not sure if there are risks when doing a lot of endurance sports while on bp medication? (And I'm not sure if the doctors will be aware of those risks when I think of the advice DH has gotten so far?)

Until now, I was sure that we do the right things regarding our lifestyle, but now I'm not so sure anymore. The thought that DH may be putting himself at risk while doing sports makes me feel really bad. I'm even asking myself if he puts himself under even more stress by trying to be active.
And I am at a loss what he could do to avoid bp medication. He said he will stop drinking coffee which he did until now and I will cook without salt as much as possible - but that doesn't seem a lot (especially when I think about the many things that obviously couldn't keep his bp at a normal level).

There are so many women here that lead a healthy active lifestyle and may have a different point of view than doctors that don't seem to be used to treating athletes. Do you have any advice?

[OakLeaf]

I'm in the same boat so I'm interested to hear what others have to say.

I actually think a lot of it has to do with your day-to-day life, not your workout routine. There have been a number of studies lately that show that it's not your "exercise" volume, it's your sitting volume that makes the difference in your health. If he works at a desk job, try a standing desk. For me, I just have to get away from the stupid computer...

Beware of not getting enough salt. That's a chronic issue for me. I hadn't even been trying to cut down and kept bouncing off mild hyponatremia until I started making sure to drink electrolyte drinks instead of plain water. (Once I even wound up in the ER on IV saline.)


ETA - Look at some of the more recent literature about overdiagnosis, too, and make your own decision whether his numbers are something to be concerned about at all. My diastolic is a whole lot higher than his, unfortunately. My acupuncture doctor was most concerned about the tight gap between my numbers, which makes mine much more difficult to treat.

[Crankin]

My DH has high bp, same situation as your DH. It's genetic (he also had 2 stents put in 6 years ago). He takes a very low dose (5-10mg) of a BP medication that is not a beta blocker. It does not affect his riding at all. There are lots of medications for high blood pressure and many have been around for years, so are well tested. You may be thinking of beta blockers, which lower your heart rate and suck for athletic people to take. My DH's cardiologist wanted him on one after his angioplasty, but that lasted about 2 days, since DH's resting HR is already super low. It's more for people like our friend, who had the same surgery as my DH, is still 50+ lbs. overweight and never does any exercise.
Unfortunately, being athletic does not always protect you from these things.

[OakLeaf]

I've been told/read that ACE inhibitors are no good for active people, either, because as soon as you start to sweat, your BP drops to the point of dizziness. And the idea of having to pee any more than I already do, makes diuretics very unattractive...

[Susan]

Thank you for your input.

He really works at a desk job, and as far as I know a sometimes quite stressful job too, but there's not so much he can do about this. Of course he can make an effort to stand up and walk around more often.

Beware of not getting enough salt. That's a chronic issue for me. I hadn't even been trying to cut down and kept bouncing off mild hyponatremia until I started making sure to drink electrolyte drinks instead of plain water. (Once I even wound up in the ER on IV saline.)

Thank you for pointing this out. From what I've read so far, it seemed to me that less salt is always better. The mentioned DASH plan recommends about 2/3 teaspoon of salt per day, which seems not much if you want to prepare 4 meals and take into account that some foods like bread already contain salt (but maybe I'm overestimating the amount of salt I normally use, I will have to watch it more closely).
We also drink plain water only.

Nice to hear that taking medication doesn't affect your DHs ability to ride, Crankin. I will tell DH that he may have to make it clear how much exercise he does, so that the doctor can prescribe the right medication for him.
My mum is on beta blockers and does not do very well on them, it's one of the reasons that I am concerned about DH taking bp-meds.

[westtexas]

One thing you might consider is switching the kind of salt you use. I would ask a human doctor before doing this, but sometimes in heart patients they have them use a potassium chloride instead of sodium salt. I don't know what the taste difference is, but especially if you are on a thiazide diuretic (which tends to help you retain sodium and lose potassium) it might be a viable alternative. I have no evidence or proof to back that statement up, but it might be worth looking in to. Another thing I have read is that sea salt may not have the negative side effects on cardiovascular health that regular salt does.

It's tough when you are doing everything right and still your health isn't perfect. I have a good friend who is fit and lean and his bad cholesterol is off the chart, despite a vegetarian diet and cholesterol losing drugs. But just think about how much worse it might be if you weren't doing everything you could already, right?

[lovelygamer]

One thing you might consider is switching the kind of salt you use. I would ask a human doctor before doing this, but sometimes in heart patients they have them use a potassium chloride instead of sodium salt. I don't know what the taste difference is, but especially if you are on a thiazide diuretic (which tends to help you retain sodium and lose potassium) it might be a viable alternative. I have no evidence or proof to back that statement up, but it might be worth looking in to. Another thing I have read is that sea salt may not have the negative side effects on cardiovascular health that regular salt does.

It's tough when you are doing everything right and still your health isn't perfect. I have a good friend who is fit and lean and his bad cholesterol is off the chart, despite a vegetarian diet and cholesterol losing drugs. But just think about how much worse it might be if you weren't doing everything you could already, right?

I have done this before and the potassium does taste different, although it has the bitterness that we identify with salt. You get used to it in a few weeks. I only switched at the advice of a doctor and I didn't have to keep using it long term.

Good luck. I don't know much about BP problems. I do know a 12 year old with them right now though, and it baffles me. She is struggling with it because of the "no activity" rules her doctor gave her. She can't play outside the rest of the summer. Mine has always been fine and I'm not even at a healthy weight.

[Fredwina]

I have broderline HT and have been taking Lisinopril for about 6 years with no problems. So trhe meds and reactions may vary from person to person.
Another thing I did not see is the time of day has an influnce on Bp(it starts out low in the morning and climbs thru the day)

[Crankin]

Yes, it is very important to make it clear how much exercise and what intensity level you do, because as we have both found out, many physicians have no concept of what we do, even though it is nowhere near competitive level. It's a lot more than what they envision, i.e. taking a walk a few days a week, or a few classes at the gym. And this becomes even more important as you age. Anyway, DH is about to ditch his cardiologist for the one he went to for a second opinion. It's a bit of a pain to go into the city, but this guy is used to working with athletes and is on the cutting edge of treatment, being at a hospital that is known around the world.
I think i need to start standing more, too, although I don't think I can do therapy standing up... I've noticed changes in my body, since I stopped teaching, which is a much more active job.

[ultraviolet]

I second taking into consideration genetic factors. Is there a history of high blood pressure in his family?

My mother has always been low-normal weight, eaten a fairly healthy balanced diet, and always active...her blood pressure is through the roof without medication. In fact, almost every woman in her family has had blood pressure issues.

And now, I have it, too. Though I didn't realize it until I started getting chronic migraines and we started digging into what was causing them. I take a daily 10mg dose of Lisinopril, and that is enough to keep my numbers low enough to a) prevent migraines and b) keep my doctor happy, without impacting my ability to swim, bike, or run.

I'm not thrilled with the idea of a daily medication, but since I've done all of the other things the doctor has suggested (mainly changes in diet, since I was already actively exercising 4-5 times a week) I was willing to do it to get rid of the migraines I was experiencing regularly. Especially because those migraines caused me to DNS four races/events in the past two years.

For the record, my doctor wouldn't treat 150/80 with medication. He would start by saying no caffeine. Then: limited sugar, taking a look at overall added salt intake and possibly adjusting that downward (though he's not entirely convinced that salt is the blood pressure demon that it's made out to be), adding more fish to the diet, and reducing refined carb intake. Caffeine is really the big one for him, though. (Of course, I go to a doctor that thinks changes in lifestyle are better for you than taking pills. So, he saves the pills until he's seen the other changes don't/won't work for someone.)

[OakLeaf]

Since I already know that my food allergies cause palpitations and increased heart rate, I started poking around to see if they could cause hypertension too.

A while back Dianyla posted a chart of histamine pathways in the body. Yup, hypertension is on there.

Up until now it hasn't really been worth it to me to adhere strictly to my allergy diet. It was like a 30% improvement in quality of life for a 200% increase in hassle. But if it'll keep me off BP meds I'll work at it. Maybe your DH should try a challenge diet, especially if he has known allergies of any type.

[zoom-zoom]

My hubby is on a couple of low-dose BP meds. I'm not sure which ones, but the ones he was originally on caused horrible edema. What he's on now doesn't.

He's very active...high BP runs in his family...this is a family of slim cyclists and marathon runners. He's 20-30#s overweight, but this isn't the cause of his HBP--it would be there even at ideal weight.

He has started to stand at work. Fortunately he works for a major office furniture manufacturer, so he was able to change to a standing height desk and has a taller office chair when he needs to sit.

Can your hubby sit on a yoga ball if a taller desk is not an option? I know a few people who do this, since it helps to work the core and requires more work to stay upright.

Another thought is to look for a physician who understands the specific needs of athletes. We really lucked-out...our doc is an avid cyclist who often commutes to the office on his bike. We're really fortunate to have a PCP who treats us as athletes and not the same way he would treat the general couch potato public. Years ago I was having knee issues and my doc and his PA both helped me find a solution that didn't = stop running...many docs would have told me to quit being active, which is backwards.