Is Your Blood Pressure Medication Affecting Your Running Performance?

Starting out on a running journey can be a daunting process. And while for many new runners it’s simply a case of plucking up the courage to strut your stuff in public, those suffering from chronic illnesses have a lot more to consider. Like, for instance, how their chronic medication will impact on their ability to run.

Do you suffer from high blood pressure? And are you taking chronic medication for your condition? Have you ever wondered if (and how) this is impacting your running performance? If so, here’s a brief summary of how each class of blood pressure medication may potentially impact your running.

How Does Blood Pressure Medication Impact Running Performance?

But before we take a closer look at the general impact of blood pressure medication on running performance, it’s worth noting that these impacts aren’t identical for everyone. First off, each different drug within each class has specific pharmacokinetics, or a specific way of moving within the body. Secondly, each individual is different. Genetics often cause variability in the uptake and metabolism of medication in the body, plus certain individuals may even have idiosyncratic responses to specific medications. Which ultimately means that no two individuals will react to running while on blood pressure medication in exactly the same way.

That said, the following general impacts on running performance are associated with different blood pressure medications:

1. Diuretics

Diuretics, or so-called “water pills”, are often the first type of medication prescribed for the treatment of high blood pressure. These drugs cause the kidneys to excrete additional water and salt, which is then expelled from the body through urine. This then lowers the total fluids, and also pressure, in the blood vessels. Which ultimately makes it easier for the heart to pump blood through the body.

According to Dr Cathy Fieseler, chairperson of the Road Runners Club of America Sports Medicine Committee, diuretics are generally not recommended for use by athletes. Since this medication forces the body to get rid of more water and salt than normal, it may lead to dehydration and electrolyte deficits in runners.

2. Beta blockers

Beta blockers work by blocking the effects of epinephrine or adrenaline in the body. In doing so, the heart beats more slowly and with less vigor, thereby lowering blood pressure. Beta blockers also assist with opening up the blood vessels in order to improve blood flow.

Unfortunately for runners, beta blockers have a detrimental effect on running performance. Through decreasing one’s heart rate by approximately 10 – 20%, beta blockers also cause a decrease in cardiac output, as well as VO2 max or aerobic capacity. You might therefore become more easily fatigued on your runs and struggle to reach target heart rates that you easily achieved before.

If running while taking beta blockers, it is therefore important to refrain from trying to get your heart rate up to pre-medication targets. You might just overdo it. Instead, try to keep your running intensity at a level that is hard, but still allows you to talk. Alternatively, you can ask your doctor to do an exercise stress test. The results of this test will enable him or her to determine a realistic new target heart rate.

Also remember that it is vital to discuss your needs and concerns as a runner with your physician. Some beta blockers are more selective than others, and may therefore have a lesser impact on your running performance. Do keep in mind, though, that a number of other factors, such as your medical history and other medical concerns, also need to be considered when selecting a suitable medication.

3. ACE Inhibitors and ARBs

Angiotensin-Converting Enzyme inhibitors (ACE inhibitors) work by inhibiting the activity of the ACE enzyme in the body. This lowers the production of angiotensin II, thereby causing blood vessels to enlarge and blood pressure to decrease. ARBs, on the other hand, prevent angiotensin II from binding with angiotensin II receptors. Through this action, they have exactly the same effect as ACE inhibitors.

Both ACE inhibitors and ARBs are generally well-tolerated by long-distance runners. Keep in mind, though, that, just like most other medications, they do come with a list of common side-effects. These include dizziness, headaches, coughing and rashes. In extreme cases, kidney failure and liver dysfunction, among other things, have also been associated with both of these medications.

4. Calcium channel blockers

Calcium channel blockers slow the movement of calcium into heart- and blood vessel wall cells. This widens the blood vessels, lowers blood pressure and makes it easier for the heart to pump blood.

According to Dr Cathy Fieseler, calcium channel blockers are generally well tolerated by runners. It is, however, once again important to keep in mind that this medicine does come with a list of common side effects, including dizziness, headaches, nausea, fatigue and gastroesophageal reflux disease (GERD). One can also not drink alcohol while taking calcium channel blockers, as it interferes with the working of the drug.

A Complicated Issue

Based on the above it is clear that, while some blood pressure medications are generally better tolerated by athletes, it’s not always simply a case of selecting the latter. A number of different factors go into selecting the best medication options for an individual, and only an in-depth consultation with your physician will bring the relevant information to light. So take the time to locate a doctor who understands your needs as a runner, and be sure to mention your running habits during your first consultation. By being as open and thorough as you can be, you can help your doctor select the best possible solution for your individual situation.