Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
International SportMed Journal FIMS Position Statement Antihypertensive medications and exercise Associate Professor Wayne Derman
UCT/MRC Research Unit for Exercise Science and Sports Medicine, Sport Science Institute of South Africa, Boundary Rd, Newlands, South Africa Introduction
results in non-compliance with the exercise prescription or the
combination of increased fat and refined
Antihypertensive medications and
carbohydrates in the diet, and a reduction in physical activity has resulted in an
their effect on exercise physiology
epidemic of hypertension, obesity, type 2 diabetes mellitus, and other chronic
A list of the categories of antihypertensive
diseases 1. Adoption of healthy lifestyles
Furthermore according to The Seventh Report of the Joint National Committee on 1. Beta-blockers Prevention, Evaluation, and Treatment of High Blood Pressure, adoption of a
healthy lifestyle forms an indispensable
hypertension 2. In fact, positive lifestyle
muscle recruitment patterns, and increase
modifications, including physical exercise
single drug therapy3;4. Lifestyle changes,
and certain non-ischaemic patients might
especially in patients with higher risk of
these agents on exercise are detrimental
to competition; however, the benefits of
antihypertensive medication prescription
chronic exercise training are nonetheless
achieved18. In general, beta-blockers are
with the normal physiological response to
perceived by the patient 7-9. This often
Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
2. Diuretics
Therefore ACE inhibitors are a good choice for hypertensive athletes. Exercise
tolerance in patients with heart failure
Older antihypertensive agents,
affected and can in fact be enhanced if the patient has congestive heart failure. Use
including vasodilators and centrally acting agents
ventricular contractions (PVCs) or false positive ECGs, particularly if
agents in this group are ingested twice to
three times a day and therefore multiple
patients have reported cardiac awareness,
which is undesirable for those participating
in prolonged exercise in the heat 20;21.
3. Nitrates
physically active hypertensive population.
7. Combination
Effects of these agents are generally as
heart failure. Exercise tolerance might be
effects of other antihypertensive agents.
lower doses of two medications to get the
Calcium Channel Blockers Practical recommendations for use
resting and exercise heart rate and generally lower the blood pressure
of antihypertensive agents in exercising individuals
usually increase exercise tolerance in patients with myocardial ischaemia.
medications for active individuals should
hypertensive patients is mostly unaffected,
individual to the agent and the effects on
5. Angiotensin-Converting (ACE) inhibitors and Angiotensin
As beta-blockers may have considerable negative effects on exercise tolerance in
II Receptor Blockers
certain patients, clinicians should be vigilant for these adverse effects and if
antihypertensive agents. ACE inhibitors,
heart rate response or exercise tolerance
during submaximal exercise, yet the blood
preferred in physically active hypertensive
Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
individuals as they do not alter exercise
Address for correspondence:
tolerance to the same extent as the beta blockers.
If the prescribing clinician wishes to use a
beta blocking agent (e.g. in hypertensive
patients with ischaemia), beta1 selective
blockers should be prescribed rather than
Use of beta-blocking agents will alter heart
References
patients ingesting these agents should undergo exercise testing whilst using the
Non-selective beta-blocking agents might
who participate in prolonged exercise in
the heat, should be encouraged to adhere
to accepted guidelines for the prevention
4. Pescatello LS, Franklin BA, Fagard R,
of exercise. A longer cool-down period is
exercise training, hypotension at rest or
clinician should be aware of this trend and
Anti-doping considerations
submaximal exercise performance in hypertensive males. Am.J.Med 1993;
blockers (certain sports) are diuretics (all
sports) are prohibited agents according to
(TUE) would be required prior to initiation
Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
16. Gordon NF,.Duncan JJ. Effect of beta-
11. van Baak MA, Bohm RO, Petri J, et al.
20. Ogawa T, Yasui K, Tomizawa T, et al.
21. Lyons D, Fowler G, Webster J, et al.
15. Baxter AJ, Spensley A, Hildreth A, et
Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
Table 1:List of generic antihypertensive agents 1. β-Blockers
Acebutolol** Atenolol Betaxolol Bisoprolol Esmolol
Penbutolol** Pindolol** Propranolol Sotalol
**Beta-Blockers with intrinsic sympathomimetic activity.
2. Diuretics (a) Thiazides (b) "Loop" Diuretics (c) Potassium-Sparing Diuretics
Triamterene (d) Aldosterone Receptor Blockers
Spironolactone 3. Nitrates Calcium Channel Blockers (Nondihydropyridines) Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
Calcium Channel Blockers (Dihydropryridines)
5. Angiotensin-Converting Enzyme (ACE) Inhibitors
Benazepril Captopril Cilazapril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril 6. Angiotensin II Receptor Blockers
Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan 7. Other older antihypertensive agents including vasodilators and centrally acting agents (a) α- and β-Adrenergic Blocking Agents
Carvedilol Labetalol (b) Direct Peripheral Vasodilators (c) α1 - Adrenergic Blocking Agents
Doxazosin Prazosin Terazosin (d) Centralα2 - Agonists and other Centrally Acting Drugs Clonidine Official Journal of FIMS (International Federation of Sports Medicine)
Antihypertensive medications and exercise International SportMed Journal, Vol.9 No.1, 2008, pp.32-38, http://www.ismj.com
Combination antihypertensive agents (a) β-Blockers in Combination with Diuretics (b) Central α2 - Agonists in Combination with Diuretics (c) ACE Inhibitors in Combination with Diuretics (d) ACE Inhibitors in Combination with Calcium Channel Blockers (e) Angiotensin II Receptor Antagonists in Combination with Diuretics (f) Diuretic Combination with Diuretic
Adapted from: ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. 2006, Appendix A. This is not an exhaustive list of antihypertensive medications.
Official Journal of FIMS (International Federation of Sports Medicine)
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