Hypertension, anti hypertensives, and rowing performance

[David Pomerantz]

Hi, I'm 50 years old and looks like of just discovered I've got high blood pressure. This is a pretty huge shock since I've considered myself athletic my whole life. I'm thinking of decreasing the after load on my heart with an ACE inhibitor or ARB. I'm curious if anyone on this forum has experience with changes in exercise performance levels when on these anti hypertensives. I'm also curious about any other side effects noted. Thanks,

Dave

[jamesg]

The main side effect that I've seen is that I'm still alive and can still row. Performance doesn't seem affected in the least, apart from expected age-related decline, but this is hardly a worry so long as I can keep fit.

I've seen no negative short-term (10 year) effects. Long term effects (>25 years), no idea. I suspect most of the pills we take will be obsolete and replaced on a shorter timescale than that, so maybe we'll never know.

Suggest you identify your risks carefully, with the help of specialists (hospitals here in Italy have specialised blood pressure units, as it's a well known killer), and then do what you like so long as it doesn't increase risk and keeps you fit. From recent examinations, it seems I've kept all my pipes clear and pressures normal. So I'm inclined to think that a combination of life-saver pills and the erg helped.

[Ralph Earle]

At the end of a rowing camp last August I had a three-hour episode of atrial fibrillation. I had been taking irbesartan for 15 years, post-TIA.

I started monitoring blood pressure and heart rate upon rising and before dinner, about 30' after exercise: median AM = 135/87, 59; PM = 135/88, 67.

My GP thought BP was too high and added 240mg of diltiazem at the end of October. From 30OCT -23FEB: AM = 123/74, 52; PM = 131/80, 61.

I didn't like the precipitous drop in heart rate, and cut the dosage to 120mg. From 24FEB-25MAR: AM = 126/77, 54; 131/78, 61.

I was quite surprised on 26MAR when in his office my BP was 117/66, especially since I suffer from "white coat" syndrome. Turns out, BP on rising and after exercise was elevated due to dehydration. Currently, ~90 minutes after breakfast, the medians are 120/71, 54.

So BP is fine, but my erg performance has suffered greatly from the low heart rate. At the age of 70 I would expect to be 10% slower than I was at 60, but it's closer to 15%. I can't rev my heart up higher than 140bpm; before diltiazem, my max was 158. Last May I did a 4:10.7 1K just for a season starter; the middle 800m were at 24spm. A couple of weeks ago, I struggled to go 4:15.1 and managed only 400m at 24 spm.

But, as my GP said, "Would you rather protect your heart and brain, or go five seconds faster?" A la Jack Benny, "I'm thinking it over!"

[David Pomerantz]

Ralph,
I'm a physician but not an internist or cardiologist. Nonetheless I remember that diltiazem is a calcium channel blocker. It will both slow down the heart and decrease the maximum force of contraction: your cardiac output takes a double hit. So I'm not a bit surprised by your lower performance. This is why I have been thinking purely of the medicines that only reduce peripheral arterial resistance.
I've done a little reading this weekend and it seems the ACE/ARBs and diuretics are the most typical starting drug for essential hypertension. The calcium channel blockers and beta blockers which affect both peripheral resistance and heart pump function (rate and force) seem reserved for patients who have already had a cardiac event. I suppose you need the diltiazem mainly for the rate control, but its also affecting the heart contractility.
By the way, my interest in erging started with an episode of a-fib. My college roommate was a varsity rower at Berkeley. I always thought myself a good runner. One day I went to run football stadium stairs with my rower roommate and he absolutely humbled me! Over the time I knew him he started to lose seat races he thought he should win. He thought he was training harder than ever but had no results. He eventually passed out at practice and got diagnosed with A-fib. All the times he thought he was discovering the nirvanah of pushing himself as hard as he could it turned out were just episodes of A-fib. End of his collegiate rowing. He was a great influence on me, and I've been erging for the last 25 years.

Dave

[Ralph Earle]

Thanks for that information, Dave.

My GP didn't mention the decrease in contraction force, and I didn't specifically research it. I did notice that the insert with the medicine mentioned brachycardia as a side -- not a main -- effect. So it's good to know I'm not making up an excuse for the performance hit.

I hope to find another way to reduce BP so I can get back in the rankings game, but anxiety about erg times raises it 10 points, so I'm probably doomed.

- Ralph

[Quatroux]

I’ve been on a low dose (50mg/day) beta blocker (atenolol /Tenormin) for 25 years. I don’t notice it having any effect during normal training. However, it does cap peak performance under maximal effort. You can change when you take your medicine (timed for after a race) or how you take it (split your dose in half and take it twice per day). Don’t skip a dose or radically change the time of day you take it. Run your plan past your doctor. If you don’t feel comfortable having this discussion, or don’t like the answer you get, you need to change doctors. It isn’t a matter of doctor shopping, but instead finding one of those rare cardiologists that understand what it means to be a cardiac athlete. Very, very few actually do. I also recommend that you take a look at http://www.cardiacathletes.org.uk. It is a community of athletes that share their stories about exercise and heart problems (some minor, most major). A common theme is how much their life improved once they got a doctor that considered their desire to train/compete and helped them satisfy that desire without jeopardizing their health.

[Bob S.]

It isn’t a matter of doctor shopping, but instead finding one of those rare cardiologists that understand what it means to be a cardiac athlete. Very, very few actually do.

Here is a great exception:

http://www.heartandhealth.us/index-1.html

Take note of the fourth paragraph.

Bob S.

[smutav]

I read some posts about 'pushing to the max' and ridiculously high MHR's and think the world has gone nuts.
EVERY rower no matter what age or fitness should realise that it is IMPERATIVE to measure your HR if 'pushing' yourself. There is ABSOLUTELY NO BENEFIT in pushing your calculated max HR beyond its limit except to do yourself and your heart potentially serious damage. THis is sheer lunacy.
I urge all rowers who want to push that hard to monitor their hearts....get a HRM or a HRM watch, its the best investment you will make !
Like many organs, the heart is forgiving...but it has its limits.

There are many max HR formulae...the most basic being 220 - age...ie.if 50 yo DO NOT for an extended period of time - anytime for that matter !...push your HR over 170 bpm, this will do more harm than good, you WILL cause damage to your body.

[Citroen]

I read some posts about 'pushing to the max' and ridiculously high MHR's and think the world has gone nuts.
EVERY rower no matter what age or fitness should realise that it is IMPERATIVE to measure your HR if 'pushing' yourself. There is ABSOLUTELY NO BENEFIT in pushing your calculated max HR beyond its limit except to do yourself and your heart potentially serious damage. THis is sheer lunacy.
I urge all rowers who want to push that hard to monitor their hearts....get a HRM or a HRM watch, its the best investment you will make !
Like many organs, the heart is forgiving...but it has its limits.

There are many max HR formulae...the most basic being 220 - age...ie.if 50 yo DO NOT for an extended period of time - anytime for that matter !...push your HR over 170 bpm, this will do more harm than good, you WILL cause damage to your body.

What a load of uninformed nonsense.

[smutav]

Up to you mate.
We all cant be as informed as your esteemed self.
Any idea what you get your HR upto? Any idea of what cardiac infarct is, how its caused, the consequences?
I call it science, people such as yourself would call it ?...well, i wouldnt know what people like you would call it...thankfully.

[PaulH]

There are many max HR formulae...the most basic being 220 - age...ie.if 50 yo DO NOT for an extended period of time - anytime for that matter !...push your HR over 170 bpm, this will do more harm than good, you WILL cause damage to your body.

...

I call it science

I think what Citroen can't be bothered to point out is that you're claiming as science something that demonstrably isn't. For example, a paper in the Journal of Exercise Physiology [1] says "the formula HRmax=220-age has no scientific merit for use in exercise physiology and related fields".

Discussion of a paper by Engels [2] points out that "if a group of 40-year-olds has an average max HR of 188, 95% of them will have max HRs somewhere between 170 and 206 -- quite a large range."

And Brian Mac, well thought of by many here, states [3] "Studies have shown that MHR on a treadmill is consistently 5 to 6 beats higher than on a bicycle ergometer and 2 to 3 beats higher on a rowing ergometer. Heart rates while swimming are significantly lower, around 14 bpm, than for treadmill running. Elite endurance athletes and moderately trained individuals will have a MHR 3 or 4 beats slower than a sedentary individual. It was also found that well trained over 50s are likely to have a higher MHR than that which is average for their age."

The point is that while the forum as a whole doesn't tend to welcome people who turn up and start insulting other members, it's even less enthusiastic about people who are insulting AND wrong.

Cheers, Paul

[1] http://www.cyclingfusion.com/pdf/220-Ag ... oblems.pdf
[2] http://faculty.washington.edu/crowther/ ... art2.shtml
[3] http://www.brianmac.co.uk/maxhr.htm

[smutav]

thanks Paul
not sure if people are being precious as my article wasnt meant to offend if that is what you are alluding to.
my article is a clear warning to people who think that they can hop into any exercise and drive themselves to extremes thinking that the more strain they put on their heart the better.
As stated the formula i described is a simple one and yes there are many and yes there are exceptions and yes there are variations too many to mention.
I m not sure how to interpret your response.
There is no science to HRmax? and yet it is a well documented and well scientifically investigated methodology and you refer to it yourself quite pointedly.
How then does one gauge how far to push oneself, given most people are amateurs with little scientific apparatus at their disposal.
If nothing else id like to get the message out three that going for broke is not beneficial and some degree of science is certainly worth applying.
So whilst appreciating your semi civil response please do not take offence to an alternate point of view, that certainly is not scientific.

[Citroen]

Up to you mate.
We all cant be as informed as your esteemed self.
Any idea what you get your HR upto? Any idea of what cardiac infarct is, how its caused, the consequences?
I call it science, people such as yourself would call it ?...well, i wouldnt know what people like you would call it...thankfully.

Thanks I'm your age 50 sample, based on a couple of discrete readings from my Garmin watch, I can get my HR up to 183 on the bike and up to 179 on the ergo. There's no history of myocardial infarction in my family, the thing that gets us is cerebrovascular accident (CVA).

There is no value in 220-age it is simply WRONG. The folks that came up with that line on their graph (with 19 test subjects) laughed [1] when Polar used it for their HR monitoring advice. 220-age was also shown to be wildly off the mark by Robergs and Landwehr [2] in their 2002 study of the 43 differing formulae for determining HR max and thresholds.

[1] http://en.wikipedia.org/wiki/Heart_rate#Haskell_and_Fox
[2] http://faculty.css.edu/tboone2/asep/Robergs2.pdf

There's very little science in this area and too much of it has wild standard deviations and shows that, in the most part, the only way you can determine anything sensible about your personal HR values is by having a blood lactate test done. You'll get some results from a step test to failure but even that is an approximation.

Part of training involves getting your body to be more tolerant to higher lactate concentrations so that you can work harder for longer. Part of that conditioning means you have to push yourself in the the AT zone and beyond that above your threshold into AN (which will happen in the last 300m of a all out 2K). If you restrict yourself by using a meaningless HR formula you'll never make it to the AT or AN zones.

There's a lot of value to only using your HR watch as a post exercise forensic tool, to see how you did, to see how that compares to other equivalent sessions. If you fixate on the watch you'll slow yourself down too often and miss reaching your potential.

[hjs]

I think you value hr to much, it should be a lot simpeler, people who are not fit should not do hard aerobic work, in that you are right. The 220 minus age is really nonsens, people should never use it, it can be wrong lots on both ends.

If a guy has a 200 max hf, reaching 170 and keeping it there is no problem. The heart itself if not sick is also not a problem, it has plenty of reserve build in. The overall fatique is a much bigger risk.

For health and fitness working to hard is not needed, but if you are fit and healthy doing so a few times a week is no problem at all.
People should use there sense, you now if you are working hard, your hf is not needed to know that.

thanks Paul
not sure if people are being precious as my article wasnt meant to offend if that is what you are alluding to.
my article is a clear warning to people who think that they can hop into any exercise and drive themselves to extremes thinking that the more strain they put on their heart the better.
As stated the formula i described is a simple one and yes there are many and yes there are exceptions and yes there are variations too many to mention.
I m not sure how to interpret your response.
There is no science to HRmax? and yet it is a well documented and well scientifically investigated methodology and you refer to it yourself quite pointedly.
How then does one gauge how far to push oneself, given most people are amateurs with little scientific apparatus at their disposal.
If nothing else id like to get the message out three that going for broke is not beneficial and some degree of science is certainly worth applying.
So whilst appreciating your semi civil response please do not take offence to an alternate point of view, that certainly is not scientific.

[NavigationHazard]

Hi, I'm 50 years old and looks like of just discovered I've got high blood pressure. This is a pretty huge shock since I've considered myself athletic my whole life. I'm thinking of decreasing the after load on my heart with an ACE inhibitor or ARB. I'm curious if anyone on this forum has experience with changes in exercise performance levels when on these anti hypertensives. I'm also curious about any other side effects noted. Thanks,

Dave

Cheers David, just now catching up to this. Back in 2007, as a 50s HW, I'd qualified for the C2-sponsored US Indoor Rowing team with a time trial 2k around 6:20 and was probably in 6:12-6:14 form. We were to compete in the European Championships in Dresden that year. The organizers required a prior, routine medical screening for competitors. Mine revealed significantly elevated blood pressure -- a shock to everyone, especially me. I was 100% sure it was either a spurious reading or else an artifact of some ridiculously difficult interval workout. However the doctors would not clear me for competition without starting me on an ACE inhibitor. I had about a week or two to get used to it before the competition. In my opinion it dramatically inhibited both my pre-race sharpening and also my performance (somehow I managed a bronze). You might find some utility in reading through my blog on the UK Forum from that period. See for example http://concept2.co.uk/forum/blog.php?b=38354 (you may have to register for the Forum to get access). For what it's worth, I went off the medication in 2008 and the problem -- if there ever had actually been one -- has not recurred. I did invest in an electronic home BP gauge and do test myself periodically, just to make sure.