Advice needed for training with hypertension

I’m having issues training with my new blood pressure medication and need some advice and/or feedback on meds for hypertension that don’t impact my performance.

But a short backstory for why I’m asking. I had not been to a doctor since before the pandemic. My previous doctor had moved to a hospital not in my network. Then the pandemic hit and the last place I wanted to be was in a hospital or doctor’s office full of Covid patients.

So my new doc prescribed Niphedipine and Losartan to lower my BP. It was 146/93 this morning.

But my on bike performance is abysmal. I rode 100 miles yesterday and averaged 16.4 miles per hour. Normally I’m averaging 18-20 mph. My avg power was way off too, and I am struggling to hold what would have been an easy tempo effort before I started the new meds.

So I’m really frustrated. I’ve got my A event for the year next month, and I don’t know a good way forward.

Is there a better class of meds that don’t destroy my performance? Or other things I could try to alleviate these issues?

Hey @Sir_Brian_M ,
I’m sorry for your frustration. Getting the right meds/dosage . etc can take awhile. You really have to work closely with your doc to get an idea of what works for you and what doesn’t. You may have to try different meds to find the one(s) that work for you. What works well for you, as an endurance athlete, is totally unique to you. If your doc doesn’t understand the endurance athlete, your best bet is to find one who does. Perhaps a referral from friends or coaches in the Chicagoland area. The various bp meds most docs recommend for endurance athletes are ACE inhibitors, Angiotensin II receptor antagonists (losartan) and calcium channel blockers (niphedipine). But like I stated, everyone is different and it may take some time for you and your physician to get the results you both want. I hope you get this resolved soon.

Spencer

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The key here is like what Coach Spencer said. You HAVE to work with a cardiologist who understands what a bicycling/endurance athlete can tolerate. I’m on a combination of two drugs and it works well for me, on most days. One thing you must understand is that with some of the drugs, especially those that limit the volume your heart will be able to pump is you will have to work in allowing that volume to flow freely. No constricting clothing and definitely nothing that will cause natural vessel constriction. That means NO caffeine before or during a workout.

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I quit caffeine two months ago, so that’s no longer an issue.

@Sir_Brian_M I can’t comment on medications but check out a whole food plant based diet to see if helps you reduce the meds that you need to take.

How To Treat High Blood Pressure With Diet

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I don’t have much caffeine input before, during and even after my rides. But if I do get a cup of coffee, I do have slight palpitations. Even gels with a little too much caffeine content doesn’t bode too well for me.

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That’s a good thing, Sir Brian. I’m a coffee addict and I get headaches if I don’t consume…

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I usually take Captoril, it helps

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Caffeine headaches are the worst. Thankfully I never got the dreaded headache when I stopped cold turkey after drinking 3-5 cups a day for 30 years.

That’s a really helpful link. And it always makes me wonder why diet & exercise aren’t the first choice for treatment. I’ll be looking at some dietary adjustments for sure. I hate taking pills.

Resigned to the meds at the moment but totally interested in weaning off them if I can control my blood pressure by eating healthier.

You’ve given me lots to think about!

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if you’re looking for more information on how exercise affects hypertension check out this review of the current evidence

(should be open access, if not just let me know)

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@Sir_Brian_M My personal experience is that doctors don’t really know a lot about diet, don’t think people can make changes and also are probably incentivized to prescribe the drugs. That was my situation for high cholesterol but going plant based also improved blood pressure. In 2016 I was at 138/88. As of my last visit I was at 100/60. I have never taken any blood pressure drugs. I eat what I want for my birthday and holidays but the rest of the time I try to stay disciplined.

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And here’s one of the representative DASH diet studies. Hundreds of people and actually well controlled diet (as opposed to the more common food-diary, observational studies).

DASH Diet, NEJM

While my blood pressure wasn’t as high as yours, about 10 months ago, I adopted the principles of this diet: massively more veg and fruit, less saturated fat. Plus I increased weekly exercise from 3 to 4 hours to 7 to 10 hours and added more intensity (that’s when I got my KICKR and started using SYSYM/Sufferfest). My blood pressure dropped to normal or near normal levels very quickly and took me out if the “maybe we should medicate” zone. Quite unintentionally, I also lost 12 pounds (not that I was particularly heavy before). I think that’s because all the veg was filling me up. The main thing I’ve had to get used to is longer prep times for every meal; a salad takes longer to prepare than a simple sandwich or buying a slice of pizza. Because you’re probably wondering, I’m 58 years old.

Good luck on your journey.

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Assuming the hypertension is your only health problem: think about just stopping your medication a few days before your ‘A event’. At high performance the blood pressure will raise in any person, this is not the main problem. More important is your mean BP in rest and during sleep.
You are taking this medication to protect your heart and vessels from damage over lots of years. It’s all about prevention. So always take in account the other factors that contribute to heart and vessels diseases: smoking, lifestyle, diabetes, obesity, high cholesterol and family history.
I would discuss this with your GP and then take your own decision.

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Are you SURE it’s the med’s? I take 100mg Losartan (the maximum dose) combined with lercanidipine (a diuretic) and have no issues as far as I know (we all react differently). Do you track all of your power/hr data in Training Peaks or Golden Cheetah? How are your CTL and ATL at the moment? Could you simply be fatigued or sickening for something? Is your Heartrate abnormally high or low vs your power output or perceived exertion?
146/93 is still a bit on the high side and I feel you will need to work further with your GP to address that. I pushed for a sports fitness test, which my Dr in the UK agreed to (this was after a TIA). My Neurologist had said no TT’s and my Cardiologist referred me back to my GP. The Sports Fitness test (measuring BP on a treadmill) gave me the OK as the diastolic (the lower number) recovered quickly after exertion. One thing that has always stuck with me though was a comment from my cardiologist “You do NOT want to see me from a hospital bed after a stroke, wishing that you had taken the medication you were prescribed” PLEASE don’t stop taking ANYTHING without consulting your Doctor - NO ONE HERE SHOULD ADVISE OTHERWISE! :slight_smile: You are likely to be on BP medication for the rest of your life, so you need to spend the time working with your GP to find the best combination for YOU. Everyone responds differently and there is no one size fits all. There can sometimes be a bit of trial and error involved - Dr’s don’t have crystal balls and can only go on the data available to them as to what has been effective in the general population and what to try when patients react badly to med’s that others have been happy with. Seriously - the event may have to be re appraised - harsh and incredibly annoying I KNOW - but in the long term you will be glad you took the time to get the med’s sorted . PS if your Systolic pressure is already high then the 200 or so mmHG it can normally reach during intense exercise cab in some cases tend upwards towards 250! You don’t want to go there :wink: Alarmist? Maybe, maybe not but…
Sincerest best wishes :slight_smile:

No, I’m not sure it’s the meds. But, my ability to hold power at FTP dropped for no other discernible reason after I started taking them. I also had a blood test and all my results came back normal.

My fitness is down as a result because I’ve not been able to train as effectively. And I do track everything on TP. While it could be something else, I was hoping that someone would mention a class of meds that is better for endurance athletes.

I am currently on 25mg Losartan and 90mg Niphedipine. But I am just starting on the meds, about 3 weeks now. I have a follow up appointment next month. My BP was 187/108 prior to starting the meds.

I don’t have any answers, and am very frustrated now, with my A event on June 18th, less than 4 weeks away, I’m losing all hope of having a great performance on event day.

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