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Draft (v2) position statement on behalf of:

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) Central α2 – 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)

Source: http://www.ismj.com/files/311417173/ismj%20pdfs/Vol_9_No_1_2008/Antihypertensive-medications-exercise.pdf

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