Athletes and High Blood Pressure

In a previous blog post, I talked about the general problem of high blood pressure, or “hypertension.” Today, I thought I’d focus our discussion about hypertension specifically on the issues that athletes face.

Here at the blog, we’ve talked about many UNcommon cardiovascular problems that athletes might confront. But hypertension is different. In fact, high blood pressure is the MOST COMMON cardiovascular problem discovered in athletes. If you don’t have this problem, you almost certainly know fellow athletes who do. And if you don’t have high blood pressure now, you might develop high blood pressure as you age. So….this is a problem worth knowing about.

First, some definitions….and we’re talking about adults here….

The NORMAL blood pressure is 120/80.

Benefits of Exercise

Randomized clinical trials have shown that physical activity is associated with a decrease in the blood pressure for all patient groups: those who have a normal blood pressure at the outset, those with high normal blood pressure or “pre-hypertension,” and those with high blood pressure. Regular and moderate aerobic exercise can reduce the blood pressure by up to 10 mm Hg. Similarly, moderate intensity resistance training (using light weights and high number of reps) can reduce the blood pressure by 3-6 mm Hg.

Regular exercise provides a real benefit. Among the physically active, the risk of developing hypertension is 50% less than for the inactive population. Nonetheless, there will be individuals who DO develop hypertension despite engaging in a regular exercise program. Those at particular risk include: African-Americans, the elderly, the obese, those with diabetes, and those with chronic kidney disease.

Evaluation of the Blood Pressure in Athletes

I’ve talked several times here at the blog about how important it is for athletes to have a physician. The BP should be checked at every visit. For student athletes, the BP should be checked at a pre-participation physical examination. It is important to remember that the BP varies over time. No single measurement should govern treatment decisions. If the BP is elevated at the doctor’s office, it may be wise to re-check the blood pressure in a more relaxed setting such as the home. You may need to work with your physician on how best to do this.

Some behaviors are known to be associated with elevated BP: increased sodium (salt) intake, tobacco use (any form), various over-the-counter medications (cold remedies, decongestants, “diet pills”), ergogenic aids (caffeine, Sudafed, cocaine, human growth hormone (HGH), anabolic steroids), various prescription medications (particularly non-steroidal anti-inflammatory drugs such as Motrin and oral contraceptives), and various dietary supplements.

Treatment of Hypertension in the Athlete

The first approach to treatment will involve “non-pharmacologic” therapy–treatment WITHOUT medications. Since we know the list of “bad” behaviors (noted above), our first efforts should be to eliminate these. We should also note that regular physical activity is helpful in this regard….but if you’re reading here, you’re probably already an athlete. Other useful measures include: ensuring adequate potassium intake (particularly for endurance athletes) and a variety of relaxation techniques (meditation, yoga, Tai Chi, etc.).

If medications are needed to control an athlete’s hypertension, several broad categories of medications are available. Each category has its own benefits and drawbacks. Anything I say here is a simplification, and there is an art and science to the selection of blood pressure medications for a patient. You will need to work carefully with your physician to choose an approach that WORKS FOR YOU.

1. ACE (angiotensin converting enzyme) inhibitors. Examples include: Altace, Zestril, lisinopril, enalapril. May be the drug of choice for athletes. There are few side effects if they are used in individuals who do not have kidney disease. Athletes taking ACE inhibitors may experience a sudden decrease in the BP just after a workout (potentially leading to blackout or syncope), so they should be aware of this possibility and have a cool-down period at the end of each workout.

2. Calcium channel blockers. Examples include: Norvasc, Calan, Isoptin, Cardizem. These medications are also useful in the athlete. They do not lead to a decrease in exercise capacity. They can lead to a decrease in the heart rate and contractility (strength) of the left ventricle (heart’s main pumping chamber), but this is compensated for by an increase in the stroke volume (the amount of blood the heart ejects with each heartbeat).

3. ARB’s (antiotensin receptor blockers). Examples include: Avapro, Atacand, Cozaar. These medications are similar to the ACE inhibitors. Again, they have a favorable side effect profile.

4. Central alpha-agonists. Examples include: Catapres, Tenex. These medications are not generally useful for the athlete. Side effects include: fatigue, orthostatic hypotension (decrease in the BP related to body position), and fluid and electrolyte imbalances.

5. Diuretics. Examples include: hydrochlorothiazide (HCTZ), Lasix. These should generally be avoided in the athlete. There is an increased risk of heat-related illness, impaired exercise capacity, cramps, and even arrhythmias. In hot weather, these medications may lead to unacceptably high losses of magnesium and potassium.

6. Beta-blockers. Examples include: Inderal, Lopressor, Toprol, Labetalol, Coreg. This is another category of drugs that should generally be avoided in the athlete. They lead to a significant reduction in maximum exercise capacity along with decreased cardiac output and VO2 max. They are also associated with increased perception of exertion and impaired temperature regulation.

Participation Recommendations for Athletes with Hypertension

Prudent recommendations for athletes with hypertension are summarized nicely in a report from the 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. For athletes with high normal blood pressure or mild hypertension, there should be no restrictions to exercise or sports participation. The blood pressure should be checked every 2-4 months. For athletes with moderate or severe hypertension, activities should be restricted until the blood pressure is controlled.

Banned Substances

The World Anti-Doping Agency (WADA) publishes a listing of medications or other substances that are banned for use by athletes during competition. Athletes should be aware of the ramifications (for their particular sport and circumstance) if they choose, along with their physician, to use medications which are included on the banned list.

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  1. says

    I was wondering. I am a 29 year old athlete who has had a BP that fluctuates between 125/70 and 145/89. Iget bad whitecoat syndrome and am usualy 130’s/70’s at home. My gp seems to want me on some type of BP meds but I am very against that due to all my sports are Powerlifting, strongman and highland games and I heard that PB meds will distory all of the above. I am also getting married soon and dont want any loss of sexual function. What do you think. Acording to your blog it seems that some of the BP drugs my make me safer without performance loss but any loss of intensity can be the difference between a win and loss.

    • says

      Im currently being treated for high bloodpressure. Ranging around 150 over 100 while in this article it is stated 160 over 100 is considered normal? Am i taking meds while i shouldnt have too?

      • Larry Creswell, MD says

        I can’t speak to the issue of your needing BP meds or not. Please continue your discussion with your doctor about that.

        I apologize if I left the wrong impression from my blog post. The normal BP is 120/80.


        • John says

          I think you should change that line, where you state that the “NORMAL blod pressure is 160/100” !!
          It’s just plain out wrong and misleading and discredits everything that comes next.

        • Miguel says

          Hi I was wondering if beta blockers are a good choice for athletes with high blood blood pressure readings at home are around 130s/70 & 120s/70 I do suffer from anxiety when I go to my doctor just thinking if my blood pressure is high. I do a lot of cardio & strength training also I’m on labetalol 200mg twice a day I’m 16 years old weight around 130 & my height is 5’5. I also get anxiety when I’m running just thinking something bad is going to happen to me like collapse or get a cardiac arrest bc of my high blood pressure that’s one of my biggest problems I have. also high blood pressure runs In my moms family.

          • Larry Creswell, MD says

            The selection of BP drugs for any single patient must be individualized. What’s good for one athlete may not be good for another.

            In general, beta blockers are effective. For athletes, they often have the unwanted effect of also lowering the heart rate.

  2. says


    Thanks for your comment and inquiry.

    Yes, I do think there are folks who have “white coat syndrome,” where the blood pressure becomes elevated simply by visiting the doctor’s office.

    You might suggest to your doctor that you take a month or so to record your blood pressure away from the doctor’s office. You could use the automated blood pressure machines at the drug store or supermarket or even invest in an inexpensive home unit (and some will measure the blood pressure electronically with little required from you). If you do this, you should measure your blood pressure at various times of the day, and in various relationships to your exercise routine, making notations in a logbook. Then, at the end of the month, take the logbook to your doctor to review together.

    If the blood pressure is consistently elevated and medication is needed, there is a wide variety of medicines that can be used. It is almost always possible to find a medication (or medications) that has an acceptable profile in terms of effectiveness (in treating the blood pressure) and unwanted side effects.

    Best of luck!

  3. says

    My son is 14 and an excellent athlete, playing in football, baseball and track. He weighs 180 and is 5ft 10in tall. He is also biracial. His blood pressure at the beginning of the football season this year was 138/70, so the trainer decided to check it every week to make sure he didn’t have white coat syndrome. It has been borderline high every tuesday of every week for the past 4 weeks. I have an appt to see a heart doctor, but i’m going crazy worried until then. Is this dangerous or can this be normal. He has no headaches or fatigue. Picture of health. Thanks worried mom.

  4. says

    Mary Kay,

    Thanks for your comment and question.

    Your son’s systolic blood pressure (the top number) seems high. Your term “borderline” is a good one. The diastolic pressure appears to be fine, at 70.

    It would be unusual to have symptoms with a blood pressure of 138/70.

    You have the right idea. Your son should have the blood pressure monitored frequently, perhaps at a variety of times of day (and in relation to training). And you’re right that this is an issue to discuss with a doctor who can care for your son over the long term.

    Individuals with borderline high blood pressure deserve careful watching.

  5. says

    If you want to improve your blood pressure, please read The Spectrum by Dr. Ornish, and follow his lifestyle program.

    High BP is very treatable. Life depends on it.

  6. says

    I posted a question on slowtwitch and a fellow triathlete send me here. What a great blog/topic.

    I am a 29yr old male in Brandon,MS and I’ve been told by a doctor and/or nurse anytime I’ve gone in to have anything done that I have high blood pressure. It wasn’t until I was in a clinic recently when the physician basically gave me 30 days of a sodium restricted diet and if things didn’t change, he’d put me on hbp meds. After researching, I’ve discovered that a)Both of my parents have hbp b)my diet really wasn’t a high sodium diet. I guess my question is- Being from Mississippi, do you suggest I see someone (or a particular group) who specializes in this sort of thing before I go on hbp medicine as a 29yr athlete, (doctor was a general practicioner in the baptist med clinic in flowood who probably writes 10,000 rx’s of Zpak to 1 rx of hbp rx).

    Thanks so much in advance!


  7. says

    49 years old. Lifetime exerciser and
    Martial artist.
    Recent stress/echo report ” hypertensive response to stress”.
    My resting/ waking BP is around 128/78. Later in the day with activity of any sort is anywhere from 138/80-155/88. I can actually tell when it is up. My exercise capacity is reduced as well. “0” calcium score. BP goes up
    As well as HR with exercise. I also feel my pulse heavily all over when relaxed or prone, making it dificult to fall asleep. Appreciate your opinion
    Appreciate you opinion

  8. says


    As you have noted, the BP can vary throughout the day and with various forms of activity, including exercise.

    It would be worth having a conversation with your doctor about this. Take along a log of your blood pressure measurements to help guide the conversation.

    Any symptoms from high BP should prompt an investigation into the cause.

  9. says

    Dr Creswell,

    Glad I found your blog. I’ve been dealing with high bp for quite awhile. I have a pretty healthy diet, I like to exercise esp. run. Right now I’m taking Cozaar (50mg)and unfortunately, it is not helping. Sometimes my top number will be normal, but my bottom number is rarely below 90. I have a stressful lifestyle (that is why I like to run-de-stress), I’ve done yoga. My primary and I are going ’round a bit. I am told to lose weight and eat healthy. My exercising and diet do not seem to help my weight (and I have kept logs to show the dr.), and basically I have been looked at like I’m exaggerating my food/exercise and retold the same things. Losing weight is somewhat foreign to me as I’ve always tended to have trouble gaining/keeping myself from being under weight. I’m having my thyroid re-tested (I have had many symptoms of hypothyroidism for the past few years). I am 41, female..and would like to know if you have any other suggestions of things I should talk with my dr. about.

    Thank you for your time,

  10. says


    Thank you for your comment.

    You mention a couple factors that can be important in blood pressure control: weight and thyroid disease. You weight should be in the “ideal” range; if not, perhaps a nutritionist oculd help make suggestions for changing the diet. And, yes, thyroid disease should be excluded.

    Beyond that, it can sometimes be a trial-and-error process for finding an ideal blood pressure medication (and dosage) for patients–athletes and non-athletes, alike. This process can take patience on the part of the patient and physician. But the rewards are worth it. Tremendous peace of mind should come from knowing that the BP is well-controlled.

    Hope those thoughts help.


  11. says

    So glad to find this blog. Need advice. I’m 64 and an avid runner. 35-40 miles a week. Have been running for 15 years and have completed 15 marathons. My cholesterol is 130 and resting heartrate of 44bpm. Have an annual EKG and echo-all normal and my cardiologist thinks I’m his healthiest patient. I am anxiety prone, particularly about my health, and have white coat apprehension. My systolic is often high at first reading-maybe 160 or 170 but my diastolic is almost always well below 90-usually in the 60s or low 70s. After the first Bp reading my systolic usually drops-sometimes by as much as 30 points!. I take losartan 100mg but can’t tell that it works. My pcp isn’t too concerned because my Bp does tend to come down to the 130s and my diastolic is usually good. I freak out about it though and often check it at home. My pcp has told me not to check it much at home because it increases my anxiety about it. I take Xanax .05mg when necessary but would rather not. Running does help with anxiety but I still find myself obsessing over my Bp. Again, my pcp and cardiologist don’t seem too concerned. Wonder what you all think. Thanks

  12. says

    I am concerned about my numbers, 128/54 62bpm. Is this large gap unhealthy? I took this reading after the first week of a new exercise routine: I ran 24 miles, swam about 8000m and did about 2 hours of resistance training. I took my reading after that first week and was well rested while taking the reading.

  13. says

    Thanks for your comment, Jeremy.

    We call the difference between the systolic pressure (top number) and the diastolic pressure (bottom number), the PULSE PRESSURE.

    For mos people, a large PULSE PRESSURE doesn’t have any particular meaning. A low diastolic pressure can be a sign of good cardiovascular health.

  14. says

    Glad I found your blog! I’ve been a runner for many years and just started competing again in 2010…mainly 10K’s, half marathons and longer XC races. I developed high blood pressure very suddenly last year. It was “normal” all year (115/55) and then in early October, it jumped….to 160/100 and didn’t go back down. After a few weeks of taking home readings and readings at the doctors office, my doctor decided we had to try meds. She put me on Amlodipine because calcium channel blockers are generally well tolerated by athletes. For about a week, I’d get dizzy after running, but then it subsided. After 4 weeks, my BP was only down to 155/100. My doctor didn’t want to up the dosage of the Amlodipine because it causes edema, and she prescribed a potassium sparing diuretic in addition to it, instead. After 4 weeks on both of them, I was down to about 135/90. Again, I seemed to adjust to them pretty quickly. It’s now been 12 weeks total and my home BP readings are around 115/60 regularly. However, I feel like my running has been suffering. I lack the endurance I had last year, even though I’ve been training the same way. I often get dizzy following faster runs. And I’m just feeling generally fatigued. A few questions for you:

    1: are these symptoms because of the meds and will the go away? Should I be trying to get off the diuretic? I plan to begin training again for several spring/early summer half marathons but it’s hard to imagine trying to do 10 miles when 6 is so hard right now!

    2: What could have been the cause of the sudden increase in BP? I’m average weight (5’3″ and about 130lbs) and I follow a “clean eating” approach to my diet. I don’t eat fast food, and I track my food daily. My sodium is not too high, I don’t eat many processed foods, I don’t smoke or drink in excess and I’m getting plenty of exercise — roughly 30 miles a week running and 3X’s a week strength training. Hypertension does run on my dad’s side of the family but would it really sneak up on me THAT quickly?

    3: What else can I do for myself to improve this? Is it probable that I’ll be dependent on meds for the rest of my life? I’m only 35 and that seems like a scary thought.

    Sorry this got so long but I’m searching hard for answers!

    • Fiorenzo Fabris says

      I can’t help but relate to your problems. I am a 62 yr. old male recreational runner now (chronic Achilles tendonitis). My story is very similar to yours. I started to take Amylodipine and it seemed to help, but lately I stopped for several months with no change in my BP. I have a bachelor’s degree in Biology, but I have become somewhat suspicious of the medical community in the last few years. This issue with high BP for athletes is troubling. How can someone who did not have high BP before, exercises and has a health lifestyle become affected? I think we have to do our own research on this. I always remember that many years ago, physicians(?) used to think that the solution to some illnesses was “blood letting”.

    • Karen says

      I’m very interested in your story because I feel that I’m in a very similar situation, but I noted a drastic change in my blood pressure after completing a cycle of Prednisone for a bad upper respiratory infection about a month ago. My blood pressure at the Dr.’s office when I was prescribed antibiotics and prednisone was normal (about 128/80). After four days of the antibiotics, Prednisone and early recovery from the Respiratory infection, I decided to proceed with running a 25K that I had been training for. The event turned out to be one of the most demanding races I’ve ever participated in and I wondered what impact that would have on my recovery. Shortly after the race and finishing the steroid and antibiotic treatment my blood pressure has been as high as 153/111 and has been fluctuating slightly lower than that for the last 3 weeks. (140’s over 90’s). I have followed up with my Primary care provider who is concerned and wants me to log my BP for the next month. I strongly feel that this change was related in some way to the course of Prednisone , and I’m concerned why it would still be impacting my blood pressure even after several weeks of finishing the medication. I’m curious if you were you using any kind of medication prior to the change in your blood pressure and if there might be a correlation?

  15. says

    At 46, I monitor food, bike at least 4 days (70 miles) per week at high intensity walk 8 miles per week, lift weight through the winter months. I’ve even used a personal trainer, but for all my efforts and clean living for many years, I have high blood pressure ranging from 125/85 to 150/100. All good practices that are supposed to moderate blood pressure have been present for a very long time. I don’t feel I have much stress. Weight loss is almost impossible no matter what I try. Full physicals turn up nothing that explains it, other than perhaps slightly elevated cholesterol. I can only summize that the medical community does not have an answer for my situation. I’m simply not willing to take drugs for a problem like this. America and the medical establishment is to eager to solve symptoms with a pill, without addressing cause.

  16. says

    I am a triathlete, age 65, and very competitive. I usually race in Olympic Length Triathlons (swim .9 miles, bike ~26 miles, run 6.2 miles) or Sprint length (1/2 mile swim, 18 mile bike, 3.1 mile run). I have done one half-iron (1.1 mile swim, 56 mile bike and 13 mile run). I exercise about 10 hours a week, mostly biking, but quite a lot of running as well (swim varies by the season, but I am very comfortable swimming a mile+ any time).

    I have a bicuspid aortic valve and HBP. My cardiologist has cleared me to do an Ironman if I want, so he regards me as in quite good health. I am taking Amlodipine, 7.5 mg/day. It seems to have effected my running quite a bit. I have trouble getting past 130 BPM. I can get up to 140 or 145 but it takes much more effort than previously. On the bike I also have some problems, but not as noticeable, as I can get up to 150 or so, and even 155. I use to be able to bike and run intensely enough to get up to 160 or 165, and I do feel slowed down by my current situation, especially with the running. My running is much slower! Also this seems to have gradually gotten worse over time. Is there any alternative med I can use, such as an ACE inhibitor?

  17. says


    There are many reasons a young athlete might have high blood pressure, including stress like you mention.

    The blood pressure varies, so it might be wise to check some more readings.

    If most of the blood pressure measurements are like the ones you mention, it would be best to visit the doctor for a careful physical exam that looks for possible causes.


  18. says

    I am 35 yo female 5’8 125lbs and suddenly became hypertensive. i did have a problem a couple of years ago and it resolved. My BP now was btw 140-155s/91-108. I am a triathlete and I am getting ready to train for an ironman next year. I went for a cardiologist workup and was placed on lisinopril which helped me right away with the high bps and the effects that went with it. What time of effect will this have on my performance. I am an pretty fast runner and cyclist and am nervous that it is going to slow me down.


  19. says


    Sorry for the slow reply.

    Lisinopril (or any of the ACE inhibitors) can be a good choice for athletes because there is not usually an impact on performance. Choosing just the right dose may take some trial and error.


  20. says


    It’s very common for any patient (athlete or not) to need some trial and error to find the best choice of BP med(s). If you’re unhappy with the current choice, meet with your doctor to discuss alternative.

    Yes, ACE inhibitors can be a good choice for athletes.


  21. says

    Dr. Creswell, thank you for a very good and informative blog. I have never had high blood pressure, borderline at times but never high. After being put on Albuterol a month or so ago by my primary care physician my BP went through the roof. Typically 160/100 or so. It also caused me to have PVCs like crazy. I stopped the Albuterol as soon as I became aware that these were side effects. Since then my BP has been high every time that I go to the doctors office. MY PCP put me on an anti anxiety medicine as well as Atenolol.

    I am an avid cyclist. I do not cycle competitively it is more for the enjoyment and the challenge of climbing mountains. Since being put on Atenolol my performance has gone down the drain. From everything I’ve read it appears that Atenolol is a poor choice for people who lead an athletic lifestyle. The Atenolol makes me feel better but I need something that isn’t going to make me suck on a mountain climb. Your information will help me work better with my PCP on a course of treatment that fits my lifestyle better.

    Thanks for the blog.

    • says


      Finding the right blood pressure medication can take some trial-and-error–for athletes and non-athletes, alike.

      Beta-blockers, like you note, are often poorly tolerated by athletes.

      Fortunately, there are many different blood pressure medications and you should be able to work with your doctor to find one (or a combination) that works well for you….and doesn’t have unwanted side effects.


  22. says

    I am a 42 year old athlete (college decathlon, post-college marathon runner, and now olympic distance triathlete). I train ~1 – 1.5 hrs a day 5-6 days a week. I have no history of heart issues, and have checkups annually.
    I take my own BP at home at night before bed. I’m finding that my BP seems to be pre-hypertension (128 – 132 / 75 – 80), but my heart rate is generally 42 – 48.
    Question: Is it possible that I have Athletic Heart Syndrome, and if so, does an enlarged heart and low HR usually produce a slightly higher BP?
    Thanks in advance.

  23. says


    Mild elevation of the systolic blood pressure (top number) is not uncommon. For most individuals, no treatment is needed. I’d encourage you to maintain a dialog with your doctor.

    Elevated blood pressure is not usually considered part of the athletic heart syndrome.


  24. says

    I’m 50, male and exercise for about 1 hour every day ( 3-4 miles running, 10-15miles biking, 2 sessions a week of cardio/weight training). My BP has been running 135-155/80-90. By charts, I’m ‘overweight’ at 6′, 220LB but I do have a big body frame. (size 38-32 pants). I’ve recently cut down drastically on caffeine (no coffee, 1 diet coke per day) and also reduced sodium and increased potassium. Oh, and my pulse is ‘low’ due to running (it’s 56 right now as I sit at my desk). Not taking any meds other than CoQ10, garlic. Any thoughts?

  25. says


    Sounds like you’re being thoughtful about borderline high BP. An ideal weight is very important.

    I’d suggest checking the BP frequently for a month or so and keeping a detailed log (time of day, relationship to exercise, foods, etc). At the end of the month, visit the doctor, share the log, and have a discussion about things.


  26. says

    Good information, but would like some insight.

    41y/o Female, 135lbs. Running 55-65/wk. Lisnopril/HCTZ(40/25) for 2 years. Rest Avg. BP was 120/70’ish. Pulse low to mid 50s. A recent spike in BP with headache (due, I think primarily to other life stress), Doc switched to Losartan/HCTZ(100/25). Now Rest Avg.was 145/80 (Pulse 65. Doc added Hydralazine (20MG).

    Do you have a sense for effect on athletic performance with the Losartan/HCTZ and Hydralazine combo? I’m out almost a month from doing marathon and am finding most of my speedwork to be difficult and unable to keep wihtin the ranges I had in January (which was also a month out from a December marathon). Didn’t have any perceivable issues on Lisnopril/HCTZ..but also began running about the time I started that combo.

    (P.S. I’m one of the oddities that running hasn’t done ANYTHING for my BP. Have had chronic High BP since at least 18 and on different types and doses of meds ever since then.)

    Thank you for your reply!

  27. says


    You’ll know from personal experience that there is some trial and error to finding the right medication(s) for athletes with high BP.

    The ACE inhibitors (eg, Lisinopril) and ARBs (eg, Losartan) are often great choices for athletes because they don’t usually impair performance in training or competition. The addition of the diuretic HCTZ causes some athletes difficulties with hyrdration, particularly when training or competing in warmer temperatures.

    I don’t have personal experience that I can share with Losartan/HCTZ/Hydralazine, but sometimes 3 agents are needed. I’d encourage you to continue to have a dialog with your doctor about the benefits and consequences of any particular combination of medications that you try.

    Lastly, you’re not an oddity. The more healthy and fit you are in general….the less beneficial effect you’ll see on the BP with running.


  28. says

    (Sorry – the reply button isn’t working for me – so adding a comment).

    I appreciate the (quick) reply. I’ve been researching to see what effects the above combos may have (athlete or not) but agree, it is trial and error since we’re all different. I’ll talk with Doc to perhaps switch back to the Lisin./HCTZ until I feel “normal” (not training for anything) and then start the trial/error process.

  29. says

    Doctor, When I take my BP with a home portable BP unit, first reading is higher than a second or third reading with a 5-10 minute intervals between readings. I like the second and third readings better most times. Can I use number the second and third BP over the first reading which is sometimes higher?

  30. says

    My doctor changed me from Atenolol (beta blocker) to Lisinopril (ACE inhibitor) and it works very well. I just had a complete heart workup and my heart is healthy other than dealing with PVCs and occasional SVTs. My cardiologist prescribed Metoprolol for the arrhythmia issues. Being that it is a beta blocker, will it affect performance as bad as Atenolol did?.

  31. says

    The only site I have found with helpful information. Many thanks!!

    I am 65 and weigh 160 lbs. I have run regularly since my student days, mainly to keep fit for competitive orienteering.

    In March 2008 I was warned that my BP was slightly raised. A problem that my mother had, but she lived to 94!!

    By January 2011 my BP was 152/97. I was prescribed Bendroflumethiazide. BP was reduced to 147/93 by September 2011.

    Medication changed to Ramipril 2.5mg in September 2011 resulting in 133/87 by February 2012.

    All this time my km times remained in 5.00 to 5.10 min range.

    24 hour monitor in April 2012 gave BP of 138/97 but with some high spikes (110) for lower reading.

    Additional medication of Doxazosin 1 mg from April 2012 reduced BP to 141/89. Increased in June 2012 to 2mg giving BP of 136/83 in August 2012.

    But from since start of Doxazosin my km times have worsened by about 20 sec a km and some training is hard work!

    Is this a recognised side effect of Doxazosin? If so, are there more satisfactory alternatives?

  32. says

    My PCP prescribed Atenolol for mild hypertension back in January and it had a very bad impact on my performance when I would go cycling. 10mg a day of Lisinopril keeps things in check very nicely. I could not get my heart rate above 135. On a good workout, it is quite happy between 155 and 165. Some recent bouts of PVCs and PACs had my PCP send me to a cardiologist. An angiogram and CTA showed no issues. I was then prescribed Metoprolol to help with the PAC/PVC issue. He must have forgot that I am a cyclist or not known what the effect of beta blockers on athletic performance.
    In your experience, would you expect Metoprolol to affect heart rate and performance to the same degree as Atenolol?

  33. says


    Yes, metoprolol and atenolol are both from the same family of medications, the beta-blockers. Both will decrease the resting and maximal heartrate and will affect athletes by limiting some portion of their upper end of performance.

    That said, the beta-blockers are also very effective for preventing PVC’s (and sometimes, PAC’s, too).

    You should discuss this issue with your doctor to see if a different type of medication would be effective, avoiding the unwanted side effect of the beta-blocker. As an alternative, some athletes who have bothersome PVC’s are candidates for ablation procedures to eliminate the PVC’s. Your doctor could refer you to an appropriate cardiologist to discuss that option.

  34. says

    Mr BP,

    Yes, I think that’s okay. We do have the ability to calm ourselves, reducing the heart rate and the blood pressure.

    My best advice is to collect measurements of the BP at different times, in different relation to the day’s activities, etc. and create a log of the results. No single measurement is most important. Instead, we look to see that the TYPICAL measurement is in the satisfactory range.

  35. says


    The side effect profile of doxazosin is good, but there are a small number of patients (~1%) who will be affected by problems such as fatigue or muscle pain, etc.

    Probably the only way to know if that’s the case is to stop/change the medication and see.

    You ought to talk about this issue with your doctor and see if a change (even if only a trial basis) could be made in the medication.

  36. says

    Im a 17 year old athlete that’s 175 pounds and 6 foot tall. I run all the time and am in good shape. I had my BP taken at the doctors office and it was 148/72 which they said was high. My mom’s friend has a BP machine that I have been using to monitor my BP. It is constantly in the 140’s. My friends where over tonight and I had them check theirs and one’s was 159/80 which sounds crazy to me but he said high BP runs in his family and the others was 151/74. We are all on the same football team and are probably the most athletic ones. Should we be worried?

  37. says


    It’s great that you’re thinking thoughtfully about your blood pressure–and your friends’ blood pressures, too!

    First, let me say that your doctor is in the best position to answer the question about being worried.

    A couple thoughts, though….

    1. Some young athletes do have mild elevation of only the systolic blood pressure (the top number). Most doctors might monitor that situation with BP checks every so often, but medications aren’t usually prescribed.

    2. For some young athletes who are muscular, a BP cuff that is too small results in BP measurements that are artifactually high. Oftentimes home blood pressure monitoring devices (that use a cuff) have a cuff that is too small for young, muscular male athletes.

    Before relying on the home BP machine, you might show the device to your doctor and ask if it’s an appropriate device for you. Another possibility would be to visit the local pharmacy, where there is often an automated BP machine, to get another check with a different device.


  38. says

    Glad I found this site, as I thought I was the only one with this.

    I am 36, 200lb, live in Luxembourg, and an avid runner/swimmer/biker, skier, etc and have been having headaches the past weeks. My BP is 145/80, body fat at 14%. Doctor put me on 5mg of Coversyl, blood work and a heart stress test as my entire family has hyper tension.

    Question is, is there anything I can do to get off the Coversyl, or other BP meds or is this something I will be taking the rest of my life?

  39. says


    Hope that your headaches improve.

    Covertly is from the class of drugs called ACE inhibitors, usually a good choice for athletes trying to avoid some unwanted side effects with other choices.

    It is possible for patients to improve things and be able to stop taking BP meds. Things to do: stop smoking, have an ideal body weight, exercise, eat a healthy diet. People who are already athletes (& already doing these things) need to redouble their efforts.

    Good luck!


  40. says

    Dr Creswell,

    I am 51 year old make with B.P 160/100 – I have exercised all my life including competing in cross country athletics, long distance swimming, volleyball, tennis, pilates etc.
    Can I assume I have a strong healthy heart able to withstand 160/100 B.P?
    I don’t want to start taking tablets at 51 years knowing I have to probably take them for the rest of my life with the thought they have side effects.

    I would really appreciate your advice.

    Best wishes


  41. says

    Thanks for this article. I want to preface this question with “I am not your average older male”. I am a 62 year old serious athlete and have been since I was 15 years old – Swimming, running, kayak Racing. I want to compete again, but as a Triathlete. Since Thanksgiving of 2012, I have been inconsistent and exercised much less than normal. I noticed that my BP has gone up to about 140/95. My doctor prescribed 20mg of lisinopril and now at rest, yesterday, my BP was 118/83. Should I expect my BP to lower somewhat since I have begun a regular (six days/week)training program.
    I am a bit concerned because both my parents take BP medication (dad’s much higher than mom’s) but they have never been exercise junkies like me.
    Thank you,

  42. says


    I think that’s a bad assumption, actually. Yes, the heart has an amazing ability to adapt to adverse circumstances….but over time it can lose battles with untreated conditions.

    I can’t be your doctor from afar, but we generally regard a blood presure of 160/100 as too high….and certainly in a range where treatment is often recommended.

    That said, as I’ve mentioned above no single measurement of the blood pressure is most important. It’s best to make a number of measurements to get an idea of the “typical” blood pressure.

    Then, even shy of medication, a number of lifestyle modifications might have a positive impact on the blood pressure.

    I’d encourage you to have a conversation with your doctor about all of these issues.

  43. says


    I think it IS possible for athletes who’ve taken a break from exercise to return to training and find that they enjoy a reduction in the blood pressure.

    I also think that the issue of the need for medications should be revisited every so often with your doctor. I tell athletes to keep a log of blood pressure measurements that they can share with their doctor at each visit.

    It sometimes can make sense to have a trial of no medications to see where things stand “off” medication.

  44. says

    Hi. I am a female college soccer goalkeeper and struggle with high BP. My dad also has high BP, overweight and has taken meds for a while now. Weight has always seemed to be an issue for me as well..right now I am in off-season and am about 230, but they also won’t let me do any team activities right now. For my built 5’10 frame, even in HS school soccer when I went through a anorexic phase, I was still around 180 or so. Anyway, my sports doctor put me on Lisinopril last year at 40mg which makes me feel really tired, and recently my blood pressure was still high at 150-160/100-110 and so she is adding Amplomidine at 2.5mg. As a college student I am SO drained all the time and take 3hr. naps everyday when possible. Is there anything I can really do about this?

  45. says

    Dr. Creswell,

    I’ve been running 20-30 miles/week for 7 years during which time my resting heart rate dropped to about 48 bpm, but with a BP of 140/90. My cardiologist at the time prescribed 5 mg Norvasc in 2009 which not only dropped my BP down to 125/80, but cut the frequency of my migraines by a factor of 10 which reduced my intake of Imitrex by the same factor. In Nov 2012 I ran 2 marathons in the span of 2 weeks. On jan 1, 2013 after a night of drinking I took an Imitrex and later that day felt my resting heart rate jump to 65 bpm and BP back up to 145/90. It was almost like a switch went off. It was accompanied by pain in my left upper abdomen and neck, and these symptoms went on for 4 weeks until I finally saw a cardiologist who diagnosed me with Pericarditis. I was prescribed large amounts of ibuprofen for it after which the pain mostly subsided by my BP and heart rate remain elevated. Blood test and echocardiograph were negative for Pericarditis. Since my vitals are not out of the realm of normal cardiologist really doesn’t think any thing’s wrong even though I’m taking double Norvasc and BP remains elevated. I’m scared to run now which is really my identity. Any ideas on what happened to me? It’s been 7 weeks now.


    • says

      Not sure what to make of the current BP med needs. Obviously, need to maintain a dialog with your doctor on that front.

      On the pericarditis front, I know it can sometimes take. Long time–weeks to months–to recover completely.

  46. says

    Thank you for this article, I felt like my doc didn’t really take into consideration that I am working out a lot.

    I am 21 years old now, and my hypertension was diagnosed in February this year with values around 155/105, sometimes more. It was already elevated last summer, but I didn’t pay much attention to it back then.

    I would consider my lifestyle as healthy, I have never consumed alcohol or nicotine, I don’t eat meat, my diet is plant based, occasionally I eat fish. It is vey low in sodium, high in magnesium and potassium. I was an athlete since early childhood with a break of a few years during puberty. I did take lots lots of Ibuprofen because of my headaches though. (I read that Ibuprofen can increase risk for hypertension, and the headaches were probably hypertension induced except for my occasional migraine, so it was a vicious circle).

    Last year I increased my work outs fro moderate to very intense, two times a day including weight lifting and anaerobic interval training to improve endurance in boxing, which I train twice a week. It is periodic though, due to my summer jobs and it depends on how much time I have to invest in studying. Still, my daily routine forces me to walk at least 5 km a day.
    My training has changed to bodyweight exercise, boxing, and running a couple of times a week at a HR of 160/min for at least 30 min, including sprints.

    The screens have sown that my kidney and thyroid gland are perfectly fine, my heart septum is hypertrophic, slightly below the limit of being pathologic. My doctor prescribed 40mg Telmisartan, and my values fluctuate as lot somewhere between 118/75 to 14x/9x.

    I find it so frustrating to have this disease and I wonder (since my doctor did not even inform himself about my exercise routines and he didn’t give me any info about a proper diet) if there is any restrictions? I love sports and I don’t want to limit myself there because of hypertension.

  47. says

    I’m 43 year old male, 138lb and 5’7″.
    At a recent medical I was told my blood pressure was high. I explained that I was anxious in medical situations so they sent me home to monitor my BP. After a few days it averaged 125/75. Silly as it may seem, it still makes me anxious taking it myself. On returning to the doctors I was told that they’d like to do an ECG. My heart was racing (98) – I was anxious! My doctor has now told me that he’d like me to have an echocardiogram as the ECG showed that I may have ‘thickening of the heart muscle.’ He also said that the results could be because I am slim (he didn’t ask if I exercised). If confirmed he said we’d have to look at lowering my BP. Strange as it seems normal outside of his surgery.
    I cycle 40-50 miles on sunday mornings with the local cycling club, play squash for an hour twice a week and swim for an hour once a week. I haven’t had the echocardiogram yet, but could the ECG results be because of the exercise? I’m hoping that it’s just white coat syndrome, crossed with the exercise I do. Possible?

  48. says


    Yes and yes.

    Yes, some individuals have an elevated blood pressure at the doctor’s office. We sometimes call that “white coat syndrome.” We often ask patients to measure the blood pressure away from the doctor’s office–either at home or at the drug store, etc.–to get measurements in a more relaxed setting. No single measurement of the blood pressure is most important. Instead, the collection of measurements is most important.

    Yes, long-term endurance sport can cause thickening (hypertrophy) of the heart muscle. And yes, this can be detected with an EKG. An echocardiogram is used to make detailed pictures of the structure of the heart to better understand the cause of the hypertrophy. It’s the starting point for sorting out whether the hypertrophy is due simply to sports or to some other problem with the heart.


  49. says

    Hi Larry,

    When you mention that the selection of an ACE might be trial and error, what exactly do you mean? Most of what I read showed that they were pretty much all the same. What sort of things would make one ‘not good’ for someone? Are there common things that I should look for? Currently, I’m partially treated with Lisinopril and having issues with exercise capacity, and difficulty going ‘hard’ (former easy 50 mile rides now feel like an 80-90 mile ride and if I try to go hard at all, I get wiped out for a little while or i just can’t go ‘hard’ at all). Could this be related to the medication choice?

    Thanks again,

  50. says


    Yes, the various ACE inhibitors work much the same and have a similar side effect profile. Sorry if I was misleading. Trial and error can be needed to choose an agent and a dosage. Some patients who cannot take an ACE inhibitor might do well with one of the ARB’s (angiotensin receptor blocker). The ACE inhibitors can also be used with the addition of a diuretic like HCTZ (hydrochlorothiazide); each can be used in lower dosage when in combination, potentially avoiding side effects.

    Feeling “wiped out” can be an (initial) consequence of lowering the blood pressure, regardless of the particular agent. In this situation, the feeling may improve with time. Again, it may take some trial and error to zero in on an agent/dosage that is both effective and well tolerated.

  51. says

    This was an excellent and informative article. Just a quick question: I was diagnosed with hypertension a about 5 yr ago (when I was only 32), and the doc suggested it was likely mainly genetic (I was veggie, low salt, and almost no processed food). I was prescribed 5mg/d of Norvasc, which I’ve been on since.

    In the past few years I’ve switched from cycling to long distance running, and generally run 10 -15 km (6-10 mi) 4 days a week, and a longer half marathon one day. A few weeks ago I injured a knee when hiking and had to stop running for 2 week…. And got incredible headaches, particularly in the afternoon, as well as just feeling awful through the evenings. Could my relatively high dose of exercise be controlling My hypertension, such that when I cut back it would spike?


    • adriam says


      I have been on this site and must have somehow missed your post. I will be 38 come February. I thought it worthwhile to make a late reply which you will hopefully read. I also experienced the same sort of thing as you, exercising on my treadmill and doing weight along with good nutrition – avoiding salt etc, and yet when I briefly stopped my bp exploded to as high as 170/100 with headaches and weird chest discomforts. I have ben taking coversyl 5mg for four weeks now and it was stabilising till the last few days when it jumped towards night time so now I take an additional half a tablet in the evening. I also wonder, if the body (cardiovascular system) is used to something and can perhaps respond negatively when it is no longer getting it?

  52. says


    I’ve learned over the years that most anything is possible, I suppose.

    I can’t think of examples of athletes whose BP has “spiked” when they take a break from exercising.

    It would be worth creating a log of your BP measurements to take to the doctor for discussion. If you have a home monitor, great. If not, perhaps you could find a drugstore, etc. with a machine. Make a measurement each day or so. I’d also take a moment to call the doctor to report the headaches. Perhaps the doctor could make some sense of that even over the telephone.

  53. says

    Hi, I am a 19 year old collegiate swimmer and have had high blood pressure since August 2012. Sometimes it’s over 140 and other times its around 125 to 135, which is still slightly high. I have also had trouble with shortness of breath and extra heart beats (palpitations) and these symptoms have been affecting my performance. I came home from college this summer in May 2013 and my parents decided to get my checked out “head to toe.” I had and EKG, Stress test, and echo cardiogram that all showed my heart is completely normal. I also went to a lung doctor and had a chest x-ray and they believe I may have a tad bit of asthma, but I dont have wheezing, but they still put me on advaire and nasonex, but I feel like the inhalers affect my heart more during swim practice.

    This has all been going on since about mid January and has been pretty frustrating to the point where I do not enjoy swimming anymore/going to swim practice I do not have any motivation.



  54. says


    Sorry to hear about the difficulties. But glad to hear that you’ve been working this summer on getting things sorted out. A couple thoughts….

    Mild elevation of the blood pressure is common. Important to have discussion with the doctor about IF treatment is needed. If not, frequent monitoring would seem to be prudent.

    Exercise-induced asthma can be a vexing problem for athletes. We know that this problem is best-controlled with regular medication rather than “resuce” medications if there’s a bad day/practice, etc. And no doubt that some of the medications that are helpful with asthma are irritating for the heart. When you meet again with the doctor you should have a discussion about the good and bad that have come with a particular medication choice….and together sort out if trial-and-error change with different medication(s) might be helpful.

    You’re not alone. And these are common issues to work through.


  55. Antje says


    So glad I found this blog, I need some help!

    I am 29, weight about 118lbs my high is 5.5. I have been doing martial arts since a little girl and competing comepetitively. I have changed from karate to thai fighting. I am now a fighter for my gym. I fight at 110lbs, so I have to cut weight in a short amount of time normally (4 weeks), which include a day of not drinking and eating. A very healthy and stick dieet.

    My BP is always normal, on the night of my fight my BP went up to 165/110 and the doc did not clear me for fighting. I did my BP a few times that night and the day after. Now 2 days later it seems to be coming down slowly. Yesterday it was 149/98 and today its 144/97 – so everyday its comes down more.

    I have never had BP and I believe it probably has to do with my stress levels the day of my fight. I am not a drinker and live a very healthy lifestyle.

    No my question is how do I control this? I think I will only have this high BP at the time of fighting and have a normal BP after. Is there medication just for a shorter period? I definitely also have a case of ‘white cloak sindrome’. So I need to be able to control this.

    Any advice?

    Kind Regards.

    • Larry Creswell, MD says

      Thanks for leaving a comment, Antje. Sorry to hear about your troubles with high blood pressure.

      My best advice is to see your doctor who can work through the issues that are specific to you. A few general thoughts….

      White coat syndrome is real. Some individuals are anxious about seeing the doctor and will have a higher-than usual blood pressure at the doctor’s office. With the blood pressure, no single measurement is the most important, though. Sometimes, patients will need to check their blood pressure at home or at the pharmacy, etc. to collect a set of measurements over days or weeks to define the “typical” resting blood pressure.

      It’s also true that the blood pressure becomes elevated with physical activity, or even with anxiety before a race or competition. But blood pressure measurements even at these times may help your doctor sort through the issue and determine if any treatment is needed.


  56. Dana says

    My son is a 19 year old college basketball player. His BP has been mildly elevated for the past year. His readings range fromm140-150’s over mid 80’s. He is 6’2″ 180lbs with a pulse in the 50’s. He is bi-racial with a family history of hypertension.

    He came home from school break where I took his BP and it was 176/87. We went back to our doctor and he was finally prescribed Norvasc 5mg. What should he and his trainers watch out for during practice, weightlifting and other strenuous activities? His doctor did not mention any restrictions for him.

    • Larry Creswell, MD says


      Your son’s doctor will be in the best position to offer advice specific to his situation. Some general thoughts….

      Many athletes do well with high blood pressure that is properly treated. In general, athletes with well-treated hypertension can participate fully in their sports. When patients–athletes and non-athletes, alike–begin taking blood pressure medication(s) for the first time, obviously it’s important to monitor the blood pressure to be sure it’s in the desired range with the new medication(s). Frequent checks can be needed. If the blood pressure is too low, patients can experience lightheadedness and athletes can experience unusual fatigue. If the blood pressure remains to high, there might be no signs at all.


  57. Dave says

    Dear dr Larry, god bless you for trying to help people. I have read all your posts and I know you know what your talking about.. I’m a 54 yr old guy with a very bad anxiety disorder my whole life.. I have been self medicating with sweat drenching cardio since I was 5 years old without even knowing it.. Aka the endorphins..

    I had a 3 sport scholarship in college , cross country, cross country skiing and track.. I was 5 ft 11 and 145 lbs then.. I got tired of being skinny and hit the body building with the same intensity.. I went to 175 lbs at 12 percent body fat at age 28.. I noticed running was much harder with the added muscle.. I never had any high b p problems till age 35.. I let my weight go to 200 lbs, I’m a carb junkie.. Due to the anxiety my systolic is always high never the diastolic .. They tried every Bo med and none worked on me .. Only 50 mg beta blocker once a day and klonopin for anxiety.. My B p is normal .. But my heart rate is only 40..

    I start every day with an hour on the life cycle, and an hr for upper body in the gym.. I’ve never drank or smoked, my dr wishes he had more like me.. I am going to lose 20 lbs to get down to 180 and 15 percent body fat again.. It seems the added muscle I put on, put me right on the edge of b p problems.. But when I got a belly it put me over the edge.. Just an FYI for your younger readers that bulking up is not good for your ticker.. My total cholesterol has never been over 150.. I think a gut does bad things to certain people’s b p.. And anxiety too.. I had a full cardio work up and my b p on the nuclear treadmill went to 200 over 100 but I could not take my beta blocker for 2 days before the tests.. Just wondering how this past 20 years of high B p when excercising and anxious has hurt my heart??

    • Larry Creswell, MD says


      I’m not in a position to comment on your medical situation from afar, but i can comment generally about high blood pressure.

      Over the long term, high blood pressure puts an extra work burden on the heart and, in some sense, the heart suffers as a result. On top of that, high BP is linked (as a risk factor) to other important medical problems like heart attack and stroke.

      The BP increases with exercise, but athletes should have a normal resting BP.


      • Dave says

        Thanks, what is a normal excercising b p for an athlete?? Or all they all different ?? For example when I was skin and bones at 5 ft 11 and 140 lbs, I’m sure my excercising b p was much lower.. Than it is since I put on 30 lbs of muscle as a body builder.. The. Added 20 lbs of fat on top of that .. I guess what I’m getting at is a 6 ft 2 150 lb marathon runners excercising b p diff than a running back football players due to the bulk??

        My resting Bp is normal .. But goes up to 190 over 100 hard out on the life cycle.. Thanks, dave

  58. Sam says

    Hi Larry, love the blog.

    I’ve always had elevated systolic pressure (130 – 150) and a diastolic of 70 – 80. Lately, I’ve noticed my diastolic dropping to the 60 – 70 range, and even as low as 55. My resting heart rate is anywhere from 55 to 75. I don’t do much cardio — probably about 60 – 80 minutes total per week — but do heavy weight training every other day. I’ve been very concerned about my blood pressure, especially since my diastolic has dropped so low. I saw a doctor and he took a blood sample to see if I was deficient in anything. I don’t yet know the results. However he told me that it wasn’t that bad.
    Obviously I am doubtful of that, which is why I am here. You seem very knowledgeable on the subject. Could this be a problem, and, if so, how can I fix it?


    • Larry Creswell, MD says

      Your doctor will be in the best position to interpret your blood pressure and recent tests.
      You ask about the diastolic blood pressure. A couple general thoughts…. Perhaps most often a lowish diastolic pressure has no particular meaning. The many causes of low diastolic pressure include: dehydration, infection, allergic reaction, various heart or heart valve problems, and endocrine disorders, among others. The list is long. Best for your doctor to help work throughout the possibilities….or let you know there’s nothing to worry about.


  59. bakerjw says

    Well, it’s been 2 years ago last December that my PCP prescribed Albuterol to aid in my breathing. That brought about PVCs (every 3 o r 4 seconds) and with it high blood pressure. First I was given Atenolol which killed my cycling performance. We finally settled on Lisinopril with it’s side effects. It got to the point with it where I just felt blech all the time and was still having PVCs. In an earlier post, my cardiologist prescribed Metoprolol but since it was a beta blocker I didn’t take it for the obvious heart rate limiting side effects.

    I hate to write a novel, but when people do google searches, different cases give them a starting point in what questions to ask and what to look for in a diagnosis with their PCP or cardiologist.

    I was still having bouts with PVCs lasting for days at a time, so I got a chance to go back in to my cardiologist. He was concerned that my last stress test showed a shadow spot on my left ventricle. His concern was that I may have had a silent heart attack. He offered 3 options, another stress test, a pet stress test or an angiogram. I jumped at the angiogram because it was the definitive gold standard for him. The angiogram showed no blockages but he was concerned because my arteries didn’t look right. Luckily a coronary CAT scan showed normal routing and no anomalies.

    With no blockages present, we started a course of Cardizem(Diltiazem) starting at 120mg and working up to 360mg. It helped a bit but made feel pretty rough most of the time. We then tried Propafenone which worked much better for a while and I felt good. But the PVCs came back every few weeks for a few days at a time. They got bad enough and I felt bad enough that I went to the ER just to be sure. I struggled like this until this last November after wearing a 48 hour Holter monitor and having another echocardiogram done.

    The drugs that usually are used to keep hearts running in rhythm just weren’t working so we are trying Amidarone. So far it has done the trick. I still have an occasional PVC, but they are much much more subdued. My only concern is the long term side effects of this drug. If anyone is planning on taking it, they should be sure to follow all of the precautions. Monday I am going in for a PFT and complete blood work up.

    I did have some headaches early on with Amiodarone and I never get headaches. The biggest side effect that I am having now is tinnitus. It is almost unbearable. Have you prescribed Amiodarone before and has that ever been a reported side effect? Studies show it as a side effect in something like 2% of cases.

    I was also put on Amlopadine because my BP was much higher than normal and my PCP is also prescribing Losartin which I have yet to start.

    My biggest concern is the Amiodarone and potential long term side effects. I’m 50 years old and trying to stay active on my bike and the last thing that I want is a permanent pulmonary side effect. Any thoughts?

    • Larry Creswell, MD says

      Thanks for sharing your story, John.

      Yes, I do prescribe amiodarone. I can’t recall having a patient develop tinnitus. It sounds like you’ve done your research about the side effects. As an aside, as a heart surgeon I’m usually only prescribing amiodarone for relatively short periods of time.

      There are many, many potential side effects of amiodarone, especially with long-term use. It sounds like you and your doctor are looking into things like lung function and liver function before using it. As with any drug, one must consider both the good and bad effects when deciding about prescribing. Best to have a thoughtful conversation with your doctor about such issues.


  60. ron perrin says

    hi Larry
    just found your great site

    my issue of worry i am 70 years old and have always been very fit with 15 to 20 miles jogging a week 4 months ago i had a tia plague in carotid artery
    prior to my tia i was takeing 10 mg of lisinopril which stablished my bp
    i still take 10 mg of lisinopril but now every 10 days my bp spikes to about 185/90 my doctor tell me not to worry but i am very very anxious about this
    i also take asprin stations and blood thinners and of course exercise the spikeing lasts about 10 hours and i take another 10mg of lisinpril what do you think larry? takecare ron

    • Larry Creswell, MD says

      I’m reluctant to offer advice for your particular situation. From afar, I don’t really have enough info.

      A couple general thoughts….

      The BP varies….from hour to hour and from day to day. That’s expected.

      I encourage patients to make a log of BP measurements….recorded at various times of day and with various relationships to exercise….and take the log to your doctor’s appointment to review together. There’s no single measurement that is most important; instead, it’s the overall pattern of BP measurements that is probably most important when making treatment decisions.


  61. Dawn says

    I am 44 yo female bodybuilding competitor and nurse I am 120 lbs and 5’5 I eat a healthy diet no red meat no salt I just don’t get it 🙂 New onset of as far as I know of increased BP I have been running 130/98 to 160/110 for the last week. I feel ok essentially have been to the doctor yesterday she gave me benicar 40mg with no effect yet. I am scared I have family history of CVA and MI. I feel like a time bomb. I take yoga and I am fairly calm in most circumstances. I am in North Dakota probably worst place to be in US for medical issues. I am here for the economy only and they are behind the times in every way. My young well intentioned Doctor is just as concerned. I have not had any testing done yet .I am working long hours and have full schedule. Help?

    • Larry Creswell, MD says

      As a nurse, you’ll know that sometimes even individuals with the healthiest behaviors can develop hypertension.

      On the bright side, it’s almost always to get evaluated for any secondary cause and to find an effective treatment, even if it does sometimes take some trial and error.

    • dave atchison says

      hi, i will share my high bp experience and hope i can 54,started lifting when i was i was too skinny..5 ft 10..140 out of high school…was into big cardio in school..cross country,cross country ski..track…started lifting at age 19…went to 175lbs w no roids..looked and felt was alot harder to run at 175lbs than 140 sure added muscle raised bp during got busy raising kids long work 175 and 15% bodyfat went to 195…my bp was right where yours was,when the extra20 lbs came on…now heres a good one for you,a guy who can swim laps an hour a day,or 45 min on lifecycle or treadmill,cant ease up on carbs to lose the 20 lbs that raised my bp….. i quit lifting but did 45 minutes daily cardio,as my life was so busy i had to pick only 1….they tried every bp med on me none worked..finally 50 mg atenelol 1x day did the trick…lack of sleep raises bp…lack of sweat drenching cardio raises bp…this helped me keep bp under control..i lift again now..and do 45 min of cardio 6 days week..when life gets too stressed or busy..choose sleep and cardio over the weights…im no dr,not even a good typist..but i had high bp that would not respond till found right med..combined w right lifestyle caffiene..plenty of sleep…weight and stress and sleep were my probs…weight is not yours,but maybe lack of sleep,which can cause anxiety,which will raise bp,and caffiene are yours..all my bloodwork is always normal past 20 yrs..150 total cholesterol..on no meds but the atenelol..good luck,calm down avoid stimulants..sleep and more cardio is my advice..dave

  62. Herbert says

    Thank you all for your comments. I am 61, active (I run 3 x a week for a total of 25 miles, and I do core strength 2 x a week), don’t smoke, don’t drink. I am 6’2#, 212 lbs. My problem is anxiety. I had an anxiety attack 5 years ago with BP at 157 over ??? (don’t remember). The ER checked me out and cleared my. Heart exams were fine too. I did not have to take medicine. In June 2013 I had a routine check up and my systolic was at 157 again. My PCP put me on Lisinopril which did not help and later on a beta blocker (Metrolopol). Eventually I dropped Lisinopril. With only Metrolopol my BP was between 118/76 and 155/95 (2 weeks ago, when I stopped taking Metrolopol. Last night my first reading was 171/98 and 2 minutes later 149/86. I am really confused. Rgds, Herbert

    • Larry Creswell, MD says


      Your story is common. It can sometimes take a bit of trial-and-error to find just the right BP medication for YOU. Stick with it. It’s important to control the BP, for sure.

    • dave atchison says

      herbert,im in your exact same boat,only it hit me alot younger. im 55 now,got hit w my first panic attack at age 31..the beta blocker was the only thing that worked on my bp..i think because our bp is brain or central nervous system related,and the beta blocker blocks adrenaline. lack of sleep will drive my b p up,so will a cup of coffee. im 5 ft 11,200 lbs,on a muscular frame, from decades of body building.i sometimes wonder if i could lose 20 lbs if my bp probs would go away? but i cant adhere to a no carb diet. i swim 45 minutes a day 5 days a week,ride a lifecycle 45 min the other 2 days,lift weights for upper body 4 days a bloodwork is all fine,and the beta blocker and klonopin is what i take for anxiety. it been helping me for over 20 yrs. dont let your bp get and stay high,take the meds if the dr says to

  63. Vickie says

    Hi…My son is 18 years old…6’0 and 165lbs. He’s a national level tennis player and has signed his NLI in November to play DI tennis. We went in to have a routine physical two weeks ago and his blood pressure was 190/90. The doctor thought this was high and took it several more times which only reduced it to 173/90. After having several more readings by a professional over the next week, it still did not improve. We are now in the process of having more test…blood test, ultrasounds of heart and kidneys, urine test. He was given Amlodipine Besylate to take once a day (half of the 5 mg tablet).

    We are nervous about what’s going on and not sure what they are looking for. Could you explain what they are looking for in the kidneys? What are the common causes of teen high blood pressure in athletes? Also, the doctor has restricted any physical activity until his appointment with a bigger university hospital which is a month away. With the summer approaching, there are big tennis tournaments that he hoped to be a part of. His health is more important but he doesn’t understand the “no activity” recommendation. I don’t want to scare him but how dangerous is it to ignore these recommendations until his blood pressure is under control?

    Thanks in advance Dr. Creswell!

    • Larry Creswell, MD says

      Thanks for sharing your son’s story, Vickie. And good luck with his continued evaluation.

      It’s probably true that, like in adults, adolescents are most likely to have “primary” hypertension if the blood pressure is elevated. We distinguish that situation from “secondary” hypertension, where some other medical problem CAUSES the high blood pressure. Among the causes of secondary hypertension are kidney causes (from diabetes, narrowed blood vessels, cystic kidney disease, etc.), thyroid disease, obesity, sleep apnea, various hormone-secreting tumors, and medications/supplements/drugs. An ultrasound of the kidneys is used to evaluate and document the size and structure of the kidneys, looking for any problem with blood flow to/from the kidneys and to assess the consistency of the kidney tissue itself. The purpose is to identify or to exclude the kidney causes of secondary hypertension.

      Obviously, I don’t know much about your son’s medical condition and, from afar, I’m not in a good position to offer advice about his activity level. I’d urge you to work with your son’s doctor(s) to decide together what’s safe in terms of tennis or other physical activities.

      Here at the blog, we’d be interested in hearing back from you once you’ve worked things through. Your experiences may well help others to understand their situations.

  64. Sunil says

    Dear Doctor,
    Hello! I am 48 yr old male with a very healthy life style – I exercise min three times a week (8 to 10 Km runs followed by strength training, core fitness and stretching), watch my food intake well, and have BMI of 23. Alcohol intake is about max 60ml, about three times a week.
    Two years back I was diagnosed to be having hypertension (140/95 to 125/90 at that time). Since then, my BP ranges between 135/90 to 120/85 despite being on medication for the last one year. I have been prescribed Amlopres 5 which I take regularly before retiring for the night. However, my BP continues to be in the same rg. Could I have your recommendations/advise on this? Thank you.
    And yes, all my other parameters (cholestrol, sugar etc are absolutely normal), nor does my family have any history of Cholestrol/sugar/BP.

    • Larry Creswell, MD says

      Have a discussion with your doctor regarding your BP goals of treatment. You may find that you’ve met the reasonable goals. If not, it sometimes takes some trial-and-error finding just the right medication(s) to achieve those goals.

  65. George says

    Hello. I’m 19 years old and i have been playing basketball for 8 years for the city club. A year ago i stopped and now i just play it on the streets. However last 3 years i have a 130/90 sometimes 140/100 BP. I’m wondering what the problem is. I went to a doctor he said that there’s nothing wrong with the kidneys, liver, pancreas, and the urinary bladder. The EKG and echocardiography are good and now they want me to wear a holter. Any thoughts why the BP is a little high or that’s just normal. Should I be afraid or not?

    • Larry Creswell, MD says

      There are many reasons for elevation of the BP. From your description, your doctor is evaluating for those possibilities. Sometimes there is no specific cause identified; we call the situation “primary hypertension.” Some people’s genetic make-up make them susceptible.

      A Holter monitor is used to record the heart rhythm on a (digital) recording. It’s designed to look for arrhythmias. This test is not usually done to identify a cause f high blood pressure.

  66. says

    I have been Cycling for 10 yrs, but my BP went up high until I was diagnose with depression and anxiety, My doctor prescribe me Effexsor and Clonazepam, since then my BP goes up and down, and I did some research about Effexsor , and it contribute a High blood pressure, last year she prescribe a Norvasc , Now I wondering if Norvasc is good for me, because Ride 30 km to 50 everyday?

    • Larry Creswell, MD says

      Worth having a detailed discussion with your doctor about the good and bad of each drug.

      There are many options for treating depression and high blood pressure. It’s usually possible to find an acceptable combination.

  67. Steven Yong says


    You mentioned in the article that “The NORMAL blood pressure is 160/100.” Is that true? I thought it’s 120/80. Could you please elaborate before I start celebrating that I do NOT have HBP, since I’m around 140/90 to 150/100.

    Thank you.

  68. Bob says

    Thanks for running this blog.

    40yo male, exercises 2-4 times a week work, travel etc permitting. 10% body fat, generally in good health. But systolic readings hover at about 140 +\- 10mmhg. Diastolic readings consistently 65-80, resting HR 58bpm. I’m consistently at the cusp of hypertension 1. Not been prescribed any meds.

    Interested in yr thoughts on long term impact of constantly being on the cusp. Any insights / opinions much appreciated 🙂

    • Larry Creswell, MD says

      Thanks for sharing your interesting question.

      Obviously, there’s no absolute cut-off to help us make decisions regarding high blood pressure treatment. And perhaps anybody who is eventually treated was “on the cusp” at some point.

      You’ve pointed out mild elevation of the systolic BP (the SBP) with normal diastolic BP. Historically, doctors have been more tolerant of this situation, but recently there’s been increased attention paid to isolated systolic hypertension. Many authorities now suggest we not be so tolerant.

      Healthy athletes are sometimes unable to make lifestyle changes to favorably impact the BP. Certainly true for non-smokers who are exercising and who are already at ideal weight.

      I find it’s helpful to make a whole bunch of BP measurements in a logbook. Make the measurements at all sorts of different times, in different relationships to exercise, eating, sleep, etc. If the preponderance of measurements show a SBP>140, it would be wise to talk with the doctor about the potential benefits of medication.

      • Bob says

        Thanks Dr Larry, makes sense and consistent with my suspicions. I have started doing as you advise and the only clear trend I’m seeing is that my BP is consistently lower immediately post intensive exercise. It drops into the 127-137 range post intensive exercise even if my HR is still elevated at about 80-90bpm.

        Perhaps this is all stress related and cycling / rowing etc flat out helps me relax. Yoga / massage etc does not have the same effect.

        Will continue to do as you advise. If you have any further ideas, I’m all ears. Thanks again.

        • Bob says

          Actually also interested in your thoughts on correlation between hr and bp. Would people have lower resting Hr eg athletes have higher bp as more blood is pumped at higher pressure fewer times per minute? Suspect the jury is out on whether this is actually harmful for the cardiac system …?

  69. adriam says

    I am a 37 very occasional drinker and non-smoker eating plenty of vegetables and fruit. I think bp problems are close to becoming a pandemic of sorts. I have only recently hit 160/102 and sometimes higher and took myself to the hospital because of how worried i was, which only made it worse. I was an active treadmill walker (consistent 25m at least a day) for 18 years without missing a day and even lifted weights twice a week for the last 2 years. I was feeling great, then the headaches began and I was told by some that i was drinking too much – 5 or more litres of water a day. I am currently on my second day of coversyl and the bp is down but the rhr is 80 or more at times. Today i had a violent reaction because i accidentally bit the tablet instead of just swallowing it – i was in the bathroom throwing up etc. I have become quite depressed with all this which is no doubt not helping matters and have stopped exercising as i am constantly worried about my bp and heart. I thought i was healthy and then this. This is quite debilitating. My brother never exercises and never has these issues. Now i wonder whether exercise has been a waste of time for me. Thanks all for reading and sharing your stories here.

    • Bob says

      Hi adriam

      Commiserations. I’m really sorry to hear that. I too am running out of healthy lifestyle actions I can take – except perhaps completely cutting out alcohol. Hoping my problems are just stress related.

      Might you have other sources of stress you can minimise too? Just an idea – will defer to the Doc for expertise.

      And FWIW do keep up with the exercise – perhaps do more even 😉 – worth giving it a shot if your doc permits it.

      Best wishes.

      • adrian says

        Thanks Bob,

        I sort of feel like I wasted a bit of my time with the weights. I am currently on coversyl and the bp has hovered around 135/90 range. I am seeing the cardio again next week as I have worn the holter, which was quite an unpleasant thing to wear all day and I have to wonder as to the accuracy of this thing as I was anxious, nervous and a little angry (during the night in particular) that the thing was going off and I couldn’t fall asleep for almost 3 hours and when I finally did the silly thing went off again and woke me up. I also sleep hugging my pillow with that arm and on my belly which would hardly make for the most accurate of readings. Anyway, you mention stress, and I do have a lot which probably hasn’t helped but some things are impossible to eliminate – as much as I love my kids they are absolute screamers and don’t help things. I am also a carer for my father who has had soft tissue sarcoma, and I often get upset when I think about my brother who comes to see him for an hour or two every week and doesn’t have to deal with all these issues. Some times we cannot eliminate the stress even though we are calm – you can trick your mind but it is like the body really knows everything any way – if that makes sense. Still doing my own cardio but I have noticed the diastolic climb when checking the bp a little after the workout, which has stressed me as well as I automatically think CAD. I spent an entire year studying nursing which doesn’t help knowing a little too much.

  70. JL G says

    Hello, Doctor.

    I am a very active martial artist, female, age 52. I also hike and swim regularly. My blood pressure seems to be stuck around 145/90. One medication make me cough. Another (Diovan, I think) made me dizzy. One actually made my hands and feet feel so cold that I was in constant pain (apparently a weird side effect that only I experienced). Norvasc 10 worked for a while, but now it doesn’t seem to be doing anything. My dr. added Coreg, but a month later, no change. I can’t eat any less or work out any more. I have no weight to lose. I feel as if I am running out of options and I’m getting nervous about it. My dr. is pretty insistent that these numbers must come down. It’s good to have a perfectionist for a dr., but sometimes he makes me freak out. Am I in immediate danger for major health problems?

    • Larry Creswell, MD says

      Your doctor’s in the best position to offer advice about BP control and to make judgments about how successful that treatment is.

      Thinking generally, even mildly high BP over the long term is unhealthy. For that reason, medications to achieve a normal blood pressure (120/80) are worthwhile.

      It can sometimes take a lot of trial-and-error to find just the right medication (or medications) and dosage that works for a particular patient.

  71. don says

    I’m 68 and have been a daily runner for 20 years. My annual cardio checkup is always good as are my annual blood works. I do take Avapro 300mg for bp. I find I often have bouts of elevated systolic blood pressure, sometimes as high as 160 or more. That number usually comes down to the 130s or low 140s rather quickly but I still worry about it. My diastolic is always below 75 and my restring heart rate is in the 40s. My doctors don’t seem concerned and feel I’m in excellent shape but I wonder if the Avapro is working or are these systolic spikes typical for an athlete my age. Thanks

    • Larry Creswell, MD says

      Sometimes it takes some trial and error with medications and their dosage to eliminate (most of) the up and down with the blood pressure. Ideally, the BP should be <120/80.

  72. adriam says

    Dr Larry,

    I am a little confused by the medical advice I am getting from my family doctor and my cardiologist, and I was wondering if you would be kind enough to weigh in on the matter? So I have been taking coversyl 5mg (1 tab daily in the mornings) and my bp seemed to have stabilised somewhat in the 140/90 range but in the last few days it has shot up 170/100 in the evenings. I realise that my anxiety about the situation is not helping and I have been prescribed cymbalta to deal with it which I have only taken for two days so far. To add to this, my cardiologist has given me a diuretic to use. From what i know, this is not the best combination but both he and my doctor insist I take all three. They insist there is no potential for harmful interaction but I am skeptical about this given the information that’s floating around. I have also seriously reduced my training to around 12minutes maximum on a treadmill, which I realise is ridiculous because of my past history of much more strenous workouts but I noticed a rhr of 95 and even 104 at one stage and I was perfectly relaxed and not doing anything (this was before i started taking the cymbalta and diuretic about 4 days ago) and have since been a little cautious. I guess, I am asking your opinion on whether you have heard of problems with such a combination of medications and whether to continue with the exercise or even ramp it up a little? Also some people have said to drink plenty of fluids with the diuretic while others have said to keep to a minimum to avoid edema. The cardiologist said that he had never even heard of cymbalta which was a little worrying. Thanks for your thoughts.

  73. David says

    Dr. Creswell — thanks for this informative site.

    Male, age 60, lifetime athlete (running, cycling). My BP readings at different times of day, different days, pre- and post-exercise range from 160/100 (not good) to 105/65 (post exercise with coffee!), with average readings approaching borderline.

    My primary physician has twice referred me to cardiologists because of unusual EKG. Echocardiograms and stress test do not show heart disease but did show ejection fraction 46%. Cardiologist stated he was not worried about heart disease or other problems given my athletic background.

    Cardiologist has prescribed Coreg (3.125mg BID). Before starting on this medication, I wanted to educate myself and landed here. You indicate that beta blockers should be avoided by athletes.

    Should I revisit my cardiologist and discuss a different treatment plan before I even start this one?

    • Larry Creswell, MD says

      Sometimes beta blockers are the most appropriate medication, athlete or not.

      Often, though, they are poorly tolerated by athletes for reasons in the post.

      The selection of a new medicine like Coreg deserves ongoing discussion with your doctor.

  74. Trent says

    Okay so I’m 14 years old and a 3 sport athlete. Recently I went to the doctor to complete a physical and my blood pressure was too high so they couldn’t sign off on it. I then have been rescheduled appointments for the past 2 month always going there with high blood pressure. It is usually in the 150/90 range. They did a EKG, chest X-ray, Eco, and blood work. Everything has came back just fine. Now i have an appointment scheduled to go to the children’s hospital to see a cardiologist. What could be the cause of this high blood pressure? And will I be able to get my physical signed to play sports?

    • Larry Creswell, MD says

      It sounds like you’re approaching things thoughtfully. It is certainly good news that the EKG, chest x-ray, echocardiogram, and blood work were normal, as you mention.

      There are many causes of hypertension. We often think of “primary” hypertension, where inherited genes, obesity, inactivity, etc. may be involved.

      Other times, there is a “secondary” cause of hypertension such as thyroid gland disease, adrenal gland disease, or kidney disease, among others.

      Your pediatric cardiologist will be expert at trying to identify a cause and provide advice about any treatment that may be needed. Perhaps you could report back when you’ve gotten things sorted out.

  75. Laura says

    I think it’s a serious oversight not to tell people that poor posture (slumping/slouching) during a BP check can increase the readings by as much as 16%. Med techs and physicians are very irresponsible, having people sit on the exam couch, arm not at heart level, body hunched — and often without any “rest” beforehand. These processes do not yield reliable readings. My son was showing BPs of 138/87, year after year, and the first time I tested him in a sitting straight position, after five minutes of rest, his BP was 123/71. He is a slumper but no medical person ever pointed this out, or noticed, or cared. Absurd. It seems to be a widespread error, and I wager lots of people on meds who don’t need to be on meds.

  76. Kelly says

    I’m currently on 10mg lisinopril, but I am starting to have some chest heaviness, fatigue and irritability. I am going to see my regular doctor in 2 days to talk about changing medications, but I was wondering… Should I stay in the ACE family or try to change completely to another one?

    • Larry Creswell, MD says

      There are many options for drugs to treat high blood pressure.
      Work with your doctor to find the drug(s) that are right for your situation.

  77. Michelle says

    My son is 14, weighs 250, is 5’10, lifts regularly with his football team and has had pre-hypertension since he was about 12. Drs weren’t very concerned because his BP sometimes was still normal but asked that I check it at home occasionally. This year he was put on 5mg of Lisinopril due to 3 high readings in the same dr visit. On his first day of Football practice he got very dizzy and sick while running the hill. His BP was 198/94. Of course they pulled him from practice. The second and third days of practice he was also pulled. I called his Dr and she up’d his meds to 10 MG and he now takes his meds in the morning instead of before bed. His BP is STILL high only during physical activity which I know will elevate it but with the meds I’m so very concerned. They have an EMT on site most of the time and his BP is taken at least 3-4 times every practice. His last reading during practice was 168/48. My question to you is should I request to have his meds increased since his BP increases so much during physical activity (but is fine otherwise) or maybe a change of meds? I don’t want him to just quit and have to just sit around and I’m worried sick about what could happen but don’t want to be that crazy overprotective momma but don’t want to lose my child to carelessness either! 🙁

    • Larry Creswell, MD says

      There’s always variability to the BP measurements. And, like you mention, the BP increases during exercise.

      You should collect all of the measurements that are made and sit down with your son’s doctor to review them. Sometimes getting the “big picture” will help with decisions about which medication(s) are best for treating high blood pressure.

      I understand your concern for you son’s well-being. You should also have a discussion with your son’s doctor about what she sees as his risk of participation in sports. No pursuit is risk-free. Perhaps together you can decide whether the risk is tolerable….or whether choosing some other activity is best.

    • Tammy says

      My 13 year old daughter has had SVT episodes and high blood pressure for a year. She is a competitive soccer player so we decided to have an ablation procedure. During pre op the doctors found a coarctation of her aorta. This condition is a congenital heart defect that we just found. It will continue to cause her high blood pressure, especially during activities. Has your son had an echocardiogram or MRI? The echo was how they found hers and the MRI provided more detail.

  78. Vibs says

    Hi Iam hypertensive and taking Telmisartan tablets IP 40 mg daily to control. Iam planning to run marathon in 3 months. Is it ok to use Gatorade and other energy drinks on race day, as they contain sodium. If not what alternative should be used??

    • Larry Creswell, MD says

      Most runners will need fluid and electrolyte replacement during/after a running race, regardless of whether or not they take blood pressure medication.

      It would be wise to discuss this need with your doctor ahead of time (& truthfully, the same issue is there while training). Limiting sodium intake can be an important part of a treatment plan to control the BP….but it’s also important to replace fluid losses.

  79. says

    I have been running for years now.. and just recently been put on high blood pressure medication by my doctor – which is labeatol.
    I am training for the marathon and all my long runs i have felt great, that is up until i have been taking this medication. I usually can run 6 miles straight (no stopping) and then fuel up. Now, since taking these meds, i am stopping (extremely exhuasted at mile 2) I dont know if its psychosomatic or the medication is burning me out. HELP!!!!

    • Larry Creswell, MD says

      Maybe labetalol?

      Yes, BP medications can affect your ability to train. Each medicine will have good effects and possibly some bad effects, too. It sometimes takes some trial and error to find the best medication(s) for an athlete patient.

  80. Carl says

    I am 66 and ride my bike 60 to 100 miles a week. Several years ago, the doc decided to put me on BP meds (BP was 132/70). Diuretics first, with were ineffective. Added Norvasc, which cause hyponatremia and almost killed me. Went to Lisinopril, which worked by eventually made me sick and again caused hyponatremia. Tried Diovan next, which worked and seemed to have fewer side effects. Insurance co. won’t pay for Diovan, so now am on irebesartan, but it makes me feel weak, am dizzy and almost black-out after a ride, and reduces by average speed by 1 mph. Without meds, my BP at home is usually 12

  81. Carl says

    Comment went out before I could finish it or edit it. Don’t know what happened. Continuing:
    BP at home without meds is usually 127/70, but at doc’s office can be 165/80. After my ride today, with 75 mg irbesartan, bp was about 95/60 and I was graying out. Ride felt terrible and legs hurt. Any suggestions.

    • Larry Creswell, MD says

      Make a journal of your (home) BP readings to take to your next doctor visit. Together, you could then review the data and make appropriate decisions.

  82. Jeherul says

    I felt lucky to have found this site.I want to know if I can strength train because one thing concerns me as my father got diagnosed with high bp few years back after suffering from low bp earlier,he is now mostly on meds and can’t get sleep without meds occasionally, his bp reads 160/100 mostly and is above 64 yrs now.I am studying bachelors in science(zoology)and strength train most days of the week with occasional cardio and my bp reads around 126/70.Should this concern if I want to build lean muscle as I also take some supps like whey,creatine,multivitamins, and recently pre workout supps which has caffeine. I am 22 at 150 lbs and pretty healthy I think,thanks in advance…

    • Larry Creswell, MD says

      High blood pressure certainly runs in families.

      The important consideration for participation restrictions, though, for athletes is their own blood pressure. Activities wouldn’t ordinarily be restricted for an athlete with a normal blood pressure.

  83. Tony says

    I have a question, apologies if this has been asked before, if you have hypertension, could that affect your breathing whilst cycling, if I do some intensive work, I pretty much can’t stay in the red for long at all. Could this be a symptom of hypertension. Also do you think an ACE inhibitor could help with this breathing issue…..Tony

    • Larry Creswell, MD says

      I’m not sure how breathing troubles might be related to high blood pressure. But both are problems that deserve your attention….and the attention of your doctor.

      ACE inhibitors are a common medication used for blood pressure control. These medications aren’t used specifically for breathing problems.

      • Tony says

        Hi again,

        Just a quick question, after having some minor surgery last week, immediately afterwards my BP was 150\103 and was up around the 140\90’s for a couple of days. I went and saw my Doc, yesterday and told him this. I said that usually my BP is around 135-145\85-92 most days, have monitored it a bit for the last month or so. He said he wasn’t too concerned unless it was consistently above the 145-150 mark. He said come back and see him if it stays above that for more than a week, he didn’t want to start me on meds until that happens.
        Does this sound too conservative, not sure whether I should go see another doc. He also said I wouldn’t feel any symptoms with my current BP readings, as I said I was feeling a little tired and out of breath. As I said previously I am a fit competitive cyclist. Looking forward to your reply.

  84. Kate says

    I am so glad to find this blog. I hope you can help me. What do you think about strees hypertension in athletes? How can I evaluate stess-hypertension? Which psyhological-tests I can use? Thank’s.

    • Larry Creswell, MD says

      Stress can definitely play a role in high blood pressure. I’m not sure what “psychological-tests” would be helpful.

      There are many strategies for stress reduction.

  85. Anil says

    this blog is really intresting, i would like to know about my high blood pressure.
    i am a bikers, usually i spend 5 to 6 hr on my bike, and i have to reach on time always to my clients, that’s why mostly i run my bike on 80 to 90 speed per hours in all conditions, whether in heavy or light traffic. i thought to drive a bike on high speed require high blood pressure for coordination. my usually blood pressure keep on 96/155. Is it common for me or i have to care about it. please guide me. thanks

    • Larry Creswell, MD says

      The normal (resting) blood pressure is 120/80. Best to give consideration for higher blood pressure with your doctor.

  86. Darrin says

    Hi Doctor,
    I am an active 47 year old male. I recently went to my doctor due to starting to notice shortness of breath during often simple physical activity (probably for the last 3-4 years, but denial with it I guess). I was concerned about heart health. I’ve never smoked and I drink moderately. My doctor diagnosed high blood pressure and high cholesterol. My (whitecoat) reading that day for BP was 182/98. Over the month I have tracked an average BP of about 132/102 and for the last week of this I have been taking 5mg of Apo-Amlodipine daily.

    This week I had a heart test (at rest and stress tested) and during the treadmill part of the test my BP reached 200/100. The lab tech kept looking at the doctor to see if she needed to shut it down due to BP readings. We finished the test, and the attending physician guessed that my heart would turn out to be okay. I await the next appt. to discuss results. I am normally quite active, in the summer I referee indoor Lacrosse at the high levels so it’s very fast and involves me running with sprints, jogs and fast breakouts. I have often done 4-6 games a day during tournaments and seem to manage that okay. It’s now off season so I am out of shape a bit. I am 5′-9″ and 185-90 lbs depending on season. So lately I have noticed shortness of breath even with stairs or carrying firewood.

    Is there anything in this that you would see as your first issue of concern? BP? My BP does fluctuate quite a bit. Any thoughts?

    • Larry Creswell, MD says

      The normal resting BP is 120/80, but the BP during exercise may be considerably higher.

      You’re correct in worrying about unexplained shortness of breath. That problem can have many potential causes, only some of them heart-related. Best to get that sorted out.

  87. Darrin says

    I should add to the above, that the last 4 years post divorce I have had probably extreme amounts of high stress in a lasting way. Thanks.

  88. Liyah says

    My boyfriend is 17 and very athletic his blood pressure is 140/80 is there ways he can get his blood pressure down and keep it down to the normal 120/80 ? He is wanting to go into the marines and needs it Down. Please please help.

    • Larry Creswell, MD says

      Most physicians will be in a position to make recommendations about high blood pressure….starting with an assessment if any treatment is needed.

  89. Faisal hossain says

    I am now 29 years old
    And my blood pressure always like 148 over 97-101. I am not taking any medication till now. I do smoke as well. What should I do now?
    My profession is business. I sleep properly less because I have small baby and have work in the morning. How I prevent blood pressure? My blood relation also have HBP problem such as my father, my uncle, etc. pls advise my siggestion….

    • Larry Creswell, MD says

      The normal blood pressure is 120/80. If the BP is greater, best to visit the doctor to get things sorted out.

  90. Dean says

    I am a 50yr old male, ex professional cyclist. In my 20’s my resting pulse rate was 40, and had frequent professional lactic, VLaMax and threshold monitoring… Its been 20 yrs since I’ve raced, and now have slowly increased from hypertension to high BP, topping at 170/110 during stressful situations. Realizing the danger in that, I have adopted several lifestyle changes, and plan to closely monitor my diet, stress, weight, etc before I use meds. If meds are required to obtain a healthy BP, can Dr’s assess my history as an athlete and the potential affects that had on my systems in order to correctly diagnose me.

    • Larry Creswell, MD says

      This is an area where most primary care physicians can sort things out. Thankfully, there are many different choices for BP medications and choices can be very much tailored to the patient.

      • Carl F says

        I am male, 67, and exercise regularly, including wt. lifting and a couple of 30+ mile bike rides a week at about 16 mph average. My blood pressure varies widely, from 90/60 (after a ride), to 145/80 (at doctor’s office), with an occasional short term spike to 180/80, depending on what I’m doing. My doc decided my pressure was too high during a routine physical (135/80), and put me on diuretics and Lisinopril. My exercise tolerance was in the tank, and I ended up in the ER with a hyponatremia (123). We then tried Diovan, (which worked but also lowered exercise tolerance), for about 2 years before again ending up in the ER with hyponatremia. I am not taking any BP meds now, not worth the risks in my opinion. Aside from Gerd (lansoprazole), I have no other issues. I am 5′-10″, 160 lbs. Do I really need to worry about BP? I now salt all my food and add salt to my water bottles, and find I feel better and have higher exercise tolerance. Latest sodium level was 135.

        • Larry Creswell, MD says

          Your question is best posed to your doctor. As I’ve pointed out, the normal resting BP is 120/80. If it’s elevated, behavior modification is needed. And if it remains elevated, medication is often needed.

  91. Elizabeth says

    I am the mom of a female college swimmer, currently age 20. She has always had low blood pressure – 96/60 give or take a point or two. She went on exchange to another country for a semester and was not able to keep up her work out regime – she has trained hard since childhood and the college training is 4 hours a day during season and 2-3 hours a day five days a week off season. After returning and resuming a regular off season training routine, she had a dentist visit where they took her bp. it was 135/60. We followed up a couple weeks later with her PA and it was 130/60. Her PA was not terribly concerned and wants her to keep an eye on it what an arm cuff – about once a week for a bit. Swimmer daughter also had her heart skip beats a few weeks ago and I wonder if it could be related, albeit I have had slight heart rhythm issues over years that are hormonal related and I train hard as a mountain and trail runner. With all of that said, she we get a second opinion? Daughter is very fit, eats super healthy, only caffeine is green tea, no alcohol. Still I am a worried mom! Thank you for your blog and for listening :-).

    • Larry Creswell, MD says

      I think that most primary care providers (MD, PA, NP) are well-equipped to sort out BP issues. Collecting measurements of the BP at various times of day, with varying relationship to exercise, away from the doctor’s office, makes sense.

      Mild elevation of the systolic blood pressure (the top number) is not uncommon in athletes. And “skipped beats” are probably not uncommon either.

      • Elizabeth says

        Thank you for your response. I will let her know to vary the times. It is just so strange that she has always been low, in bop, until this year. She did have a heart murmur growing up but it has diminished to point of barely being able to detect. Not sure if any connection. Her GP has talked about some further testing but May have to wait now until after season. GP is not considering daughter in any danger at this point. Thanks again!

  92. Melinda says

    My son is 21 yrs old and plays D-1 football. He has always been healthy and played a variety of sports. He had to gain a large amt of weight to play his position in college and got up to 290 lbs. at 6’4″. He was struggling with the intense cardio/ conditioning and shortness of breath, cramping and numbness in legs during hard core workouts. Found out his BP was elevated approx. 145/90ish. He was sent for an echo cardio stress test and the first time his BP hit 250/115 only 6 min. into the treadmill. Put him on amlodopine and two weeks later another stress test, more or less same result, they stopped him when systolic hit 245 at approx. 6 min again. Upped his amlodopine and after another full month on meds he did a final stress test and this time it took about 11 min. But his exercise BP again hit 248/90ish. Cardiologist did CT scan and found nothing abnormal with heart. BP is still running high about 143/85 at rest. Very concerned as he is so young,and very active, and since first test he has lost 22 lbs and no change in BP. Hasn’t participated in football for months trying to figure this out. In your opinion is this exercise induced BP unusual and dangerous? VEry worried about his health and high BP so young. Wonder if there is anything we are missing. Thanks.

    • Larry Creswell, MD says

      I can hear your concern, Melinda. And there’s reason.

      From afar, I’m not sure that you’re missing anything. It sounds like you’re getting things looked after.

      It’s true that the BP increases with exercise, to a different extent in different individuals. And it’s true that we ordinarily prescribe BP medications to treat the resting BP.

      It would be best to have very forthright discussion with your son’s cardiologist about what forms, and what intensity, of exercise may be safe.

      • Billy says


        I’m 43 year old male. I was diagnosed with high blood pressure by md. He has me on norvasc 10 mg and for cholesterol he has me on Lipitor 10 mg. Both to be taken once a day. Well I was rushed to the ER the other day with a blood pressure of 247/131. Also had pain in my left arm. Nitro pill was given and pressure went down. After many tests on the ER I was sent home and was told to see my MD. I was also told that these two types of medication should not have been prescribed to me. They don’t belong together. Also was told that norvasc is generally given to people who re much older than me. Is that true?

        • Larry Creswell, MD says

          You’re young. So, in truth, most all of the BP medications are generally given to people who are older.

          That said, I would think that there are many people in their 40’s who are taking Norvasc.

  93. Tony says

    Hi Larry,

    Earlier this year my doctor sent me for an ECG, where they found a dilated aortic root 47mm, no other issues, I have also had a calcium score done which is normal, I had a exercise stress test done which also showed up nothing. My BP is usually around the mid 130’s/80’s, also had a CPET done which showed up nothing untoward either. The cardio specialist said to follow this up in 2 years
    I am a 52 yr old cyclist who still competes, I have been reading about restrictions for athletes with a dilated aortic root, do you think I should question my doctor, who has not warned me about continuing my cycling competition. Thanks in advance…..Tony

  94. says

    Just curious – @ 195 lbs (lean) 5′ 11” 62 y/o fairly athletic meaning competitive tennis usually @ 5 times a week – weight training usually twice a week 20-30 minutes power sets and enough weight to challenge myself – bowling 6 or more games a day 6-7 days a week (15 lb ball) – my resting bp (sitting up) is usually @ 130/75 – sometimes 120’s but usually 130’s … hr is @ 76 fairly consistently (all measured with one of those automatic home units from CVS) …. High BP does run in my family – I do smoke a pipe and I do take Advil fairly regularly (knee and hip not incapacitating but can complain if I over do tennis 🙂 ) … Anyway – these numbers seem higher that what I see others here listing so wonder if I need to look into this more or professionally.

    • Larry Creswell, MD says

      Well, I would never argue with visiting the doctor!

      As you’ve read in the post, the normal BP is 120/80.


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