Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Hiking and hypertension medications

Last week I started taking Benazepril (ACE inhibitor) and Metoprolol (beta blocker) for hypertension. My doctor says no limits or special considerations for exercise. On the other hand, he is not a hiker and may not know exactly what it's like to trudge up the switchbacks. Does anyone here have experience taking these medications? If so, are there any adverse effects during strenuous exercise? Thanks for your help!

I have taken a beta blocker, for hypertension, for several years and the only side effects were in the first few months and then only while resting, never while active.
Quickly my body adjusted.

You will have to determine how your body tolerates the combination of drugs and the dose.
I started with shorter, less aggressive hikes for a while, just to see how I felt. Now I am capable of six thousand foot vertical gains and 12 hour day hikes without problems,(other than sore knees, sore back, and sore everything else).

I suspect you will be the same.

Ken Murray can express this better than I, but the protective effect of a beta blocker will typically limit your cardiac output, i.e. pulse rate. Think of it as a governor on an engine. I took Atenolol for awhile and while it worked great at lowering my BP, I found that my heart rate would not go higher than ~130. The result of this was a significant reduction in my climbing capacity, especially at altitude. Talk to a cardiologist who has experience in treating athletes and get him to work with you to find the best combination of meds for your specific condition and lifestyle.

Dave is generally correct about the effect of beta blockers (nice description!), but there has been a trend in the last few years of using multiple medications in lower dosages, to reduce the potential for side effects (each drug class tends to have different side effect potentials).

This has been particularly true of this class of drugs, and so, as they say, your mileage may vary......

However, if you find yourself exercise limited, there are many other choices of hypertension meds that will not do that, but will get the BP down, and your doc should be able to guide you on that.

as for heart rate 130,
that is at about the anaerobic threshold (AT) for me and for most weekend warriors. This is a comment on sustainable activity level, ie, hiking all day, versus a short burst of power using maximum output - see below.

So if 130 is my max rate on beta blockers then I would not need any higher, anyway, unless I am Lance Armstrong whose AT is said to be 170.

Now, if you need a very short burst of activity (and burst of heart rate to 200) to achieve maximum oxygen consumption and energy consumption (MVO2), then you can't do that, and maybe you shouldn't either.

There is no way the MD can predict what your response will be on those drugs on the mountain. In the lab, a treadmill test will record bp and pulse rate, both of which go up as you exercise. When I first got into backpacking at age 40, that is the first test I asked for. It can be very useful. You can also do it yourself with at least a pulse watch and even a portable battery-powered bp cuff, or an "old-fashioned" manual bp cuff. You can test yourself around home or the park before you go off to Whitney. Simple. To answer your questions specifically for your situation, you need facts, not just anecdotes from others.

Dr. Harvey, is, of course, correct.

You'll want to do some work on yourself to see what the situation is going to be...it may be a total non-issue.

I meant my comments to be addressing the drugs, not the patient.

The effects of medications on exercise have been answered in the previous posts; again, the beta blocker is the one that would have the effect on intensity of exercise, as has been mentioned, together with the other caveats. There is another aspect of these medications that is separate from the performance aspect, and that is the changes that occur in fluid regulation and blood vessel resistance. The ACE inhibitors work by decreasing the amount of resistance in the vascular system, thereby allowing blood to flow more freely. Beta Blockers slow down the heart rate. If you were to go from a relatively high level of exertion (as much as the B blockers would allow, of course) to a dead stop, the combination of slow heart rate, low bp, and increased vascular bed and decreased resistance could cause you to pass out due to pooling of the blood in the lower extremities and resultant insufficient blood flow to the brain. Add to this the dehydrating effects of altitude, add in a little sun on a summer day for additional dehydration, and you have the potential for light-headedness, not something you want to be dealing with if you happen to be in a particularly dicey area on your hike! In addition, I would remind you that Diamox is a potent diuretic that is used to treat hypertension, so I certainly would be wary of using that drug if that has been your previous practice. Keep in mind that fluid regulation will be more important for you than someone who is not on these medications; I would keep an eye on electrolyte levels as well in particularly warm or dry conditions, i.e. when there is a high rate of sweat loss.

I'm not sure where people get the sense that Diamox is a potent diuretic, it is, in fact, a very weak one. It is not used to treat hypertension (in the US), at least in the last 30 years, who knows before that.

It should probably also be mentioned that many side effect issues with hypertensive medications are more pronounced right after the drugs are started. After awhile, the body seems to adapt.

(Disclaimer: I am not a doctor)

I would also add that most of the people I have known who had diuretic reactions from Diamox, started with too high of a dose. The actual dosage on my perscription is 500mg a day, and even when I tried half that much, I noticed side effects. After settling in at 125mg per day, I reaped the benefits with almost no diuretic side effects.

B

Richard, your message struck a chord. I am not a doctor, but have been taking Metoprolol since last August, 50 mg. twice a day. Some people will have an adverse reaction to medication. Others won't. When it vomes to Metropolol, I am one of the former. I swim competitively. Metropolol has had a significant effect on my aerobic capacity that would likely be comparable to hiking at 10,000 plus feet. You cannot simply stop taking Metoprolol. However, I have since reduced what I take to 25 mg. twice a day and my aerobic/pulmonary capacity has improved markedly. I am doing everything I can to get off it entirely.

I would be happy to talk to you further if you pm me, but you really need to listen to your own body and speak up to your doctor if you have any concerns.

My apologies...Diamox is currently used for a variety of other problems, not hypertension. Of course, it is still a diuretic; maybe potent is the wrong choice of words to use, but, as Bee has mentioned, there is probably going to be some variability among individual responses, as well as differences depending on dosage...it is still an additive effect on the other BP medications.
I would also like to comment on the adaptation aspect. Certainly a lower dosage of medications or the current combo methods will decrease any side effects; I cannot talk for what any one doctor may prescribe to their patient. However, when it comes to a medication such as Beta Blockers, the whole point is to lower the BP; B blockers do this by lowering the max heartrate. There is not much adaptation that is going to occur that will allow that HR max to increase...if for any reason it does, the dosage would be adjusted in order to lower it again. Over the years I have seen a number of cases where there has been an adverse exercise response to meds, including light-headedness and fainting...this has occured in those who have taken the meds for years as well as those recently on meds. There are a number of individuals on this board who have been on Beta Blockers for years and have had to curtail their intensity during hiking...no amount of time is going to reverse that short of decreasing the dosage or getting off it entirely.

Richard, Be aware that one of the side effects of Metoprolol is achy muscles and joints (like the day after working out too hard at the gym after a long absence) which can be muscle damaging over time. That was my case and my Dr. took me off it immediately after I told him my symptoms..........steve

Thanks to everyone who responded to my post. The answers have been very informative. I have done only one hike since starting the meds. I deliberately made that one a walk in the park (8 mi RT, 1400' gain) just to see how I would react. I did feel a bit light headed when we stopped at the end, but not while hiking. I intend to gradually increae distance and altitude gain to see what happens. Diamox is not an issue. I have never used it and don't need it. I am a great believer in hydration and drink lots of Cytomax and plain water on my hikes.

While Diamox could have an additive effect on BP, I've not been able to find any literature support for this. I think it is just too weak.

Beta blockers lower the BP by relaxing the vasculature, increasing the size of the flexible container that holds the blood, decreasing the pressure. It does not do this by lowering heartrate. In fact, these are two different properties of the beta blocker class, beta-1 and beta-2 effects, and different beta blockers have a different mixture of predomination of the two effects, unless my understanding is quite wrong.

http://www.medicinenet.com/high_blood_pressure/article.htm

http://www.livestrong.com/article/28814-beta-blockers-work/

I think the comments about side effects of beta blockers is right on, but previously were talking about ACE inhibitors, which is a horse of another color.

I'm not trying to bore the audience with an obscure discussion of pharmacokinetics and pathophysiology, but hope that people will discuss changes with their physicians, who are trained in this, and should know their patients better than anyone else.

Ken, while it is true that Beta Blockers relax the vasculature through the inhibition of Renin release, thus leading to less resistance and lower BP, their initial and most important action is to lower Heart Rate and Myocardial contractility. Recall that Beta 1 receptors, which are found in the heart, are stimulated by epinephrine, which is the primary driver of increased heart rate in exercise, as well as being important in other forms of stress, such as the fight-or-flight response. Selective beta blockade will block the adrenergic receptors, preventing epinephrine from binding to them and activating a cascade leading to both an increase in heart rate and an inflow of calcium into the myocardium which would increase the contractility of the heart. Thus, Beta Blockers prevent this epinephrine-driven increase in HR and contractility, thus decreasing cardiac output. In fact, they are one of the medications of choice after cardiac surgery in order to prevent the heart from working too hard as it recovers, which could lead to adverse consequences.

Actually found this article on one of the site links you posted...

http://www.livestrong.com/article/27062-beta-blockers-lower-blood-pressure/

Well, I guess we'll have to agree to disagree.

When using a BB to lower BP, slowing the heart and reducing contractility, in my opinion, is a side effect and undesirable, and thus the development of selective BB to avoid this.

Note that this side effect issue is the subject of this entire thread.

When using BB to treat damaged myocardium, such as after a heart attack, slowing the HR is the primary desired effect, and lowering the BP is the unwanted side effect, since that can reduce the oxygen delivery to the myocardium...and thus the development of selective BB's to avoid THAT.

The selective BB's used for the first situation are different than the selective BB's used for the second.

Heart failure is yet another situation, that is more complex than either of the above.

So, I don't think one can make blanket statements about the desirable effects, and unwanted effects of these potent drugs, in their various manifestations. Skill in the use of these drugs, and usually a lot of experience managing them, is generally a great idea.

My cardiologist put me on Metoprolol last summer. I work out at the gym and the first thing I noticed was I could not get my heart rate up to the normal 128 when on the elliptical. It would stay about 118 or lower, not matter how hard I tried to raise it. They also made me feel tired. I had very angry dreams, and would lose my cool over little things. Now, perhaps I live on the edge, ready to tip at the least thing, but for the last 60 plus years, I have controlled them where I can live in society and be productive. I hiked Whitney in September last year, but just a couple weeks before, I decided to go to another cardiologist for a second opinion. He immediately took me off the Metoprolol as well the statin I was taking. He said my heart rate was way too low. He basically said the other doctor was way too aggressive in treating my slightly high blood pressure and cholesterol. My CPK numbers were too high from the statin, and as long as I took it there was nothing I could do about the muscle problem. So, for the past 7 months I have not been taking anything for the slightly elevated blood pressure or potentially high cholesterol. I go back to the new cardiologist next week to be evaluated again after being off the meds. I have been monitoring my BP and had blood drawn this morning for a current cholesterol test. When he took me off the meds in September, he commented that there were other ways to treat high BP and high cholesterol without the side effects I was having. I have been very active my whole life and became borderline high as I approached my 50's (under control prior from exercise and diet).

I offer this so that you might want to consider getting another opinion. I had been going to my old cardiologist for the past 10 years. I do not have any heart problems, but am well aware that cardiologists are better at keeping you heart healthy than the general family doctor. They tend to look for things that the family doctor may not. Yes, they do cost more, but we never hestitate to buy a new sleeping bag or backpack.

This is the generally accepted view:

http://www.cvpharmacology.com/cardioinhibitory/beta-blockers.htm

Beta-blockers decrease arterial blood pressure by reducing cardiac output. Many forms of hypertension are associated with an increase in blood volume and cardiac output. Therefore, reducing cardiac output by beta-blockade can be an effective treatment for hypertension, especially when used in conjunction with a diuretic. Acute treatment with a beta-blocker is not very effective in reducing arterial pressure because of a compensatory increase in systemic vascular resistance. This may occur because of baroreceptor reflexes working in conjunction with the removal of β2 vasodilatory influences that normally offset, to a small degree, alpha-adrenergic mediated vascular tone. Chronic treatment with beta-blockers lowers arterial pressure more than acute treatment possibly because of reduced renin release and effects of beta-blockade on central and peripheral nervous systems. Beta-blockers have an additional benefit as a treatment for hypertension in that they inhibit the release of renin by the kidneys (the release of which is partly regulated by β1-adrenoceptors in the kidney). Decreasing circulating plasma renin leads to a decrease in angiotensin II and aldosterone, which enhances renal loss of sodium and water and further diminishes arterial pressure.

http://www.bystolic.com/beta-blockers/

A beta blocker is a medication that slows the heart rate and reduces the force with which the heart muscle contracts, thereby lowering blood pressure. Beta blockers do this by blocking beta-adrenergic receptors, which prevents adrenaline (epinephrine) from stimulating these receptors.

There are several other factors that may contribute to how beta blockers work, including suppression of renin, an enzyme released by the kidneys, and decreased sympathetic activity.

In addition, beta blockers can be described as either “selective” or ”nonselective” and “vasodilating” or “nonvasodilating.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697096/


Beta blockers exert antihypertensive effects by reducing myocardial contractility, heart rate, and cardiac output.9,10 Central inhibition of sympathetic nervous system outflow, inhibition of the renin–angiotensin system by reducing renin release from the juxtaglomerular apparatus, and resetting or altered sensitivity of baroreceptors may also contribute to the BP-lowering effects of this drug class.9–11

On the other hand, here is a research article about the complications that can occur with lowering HR in hypertensive individuals who have not suffered any cardiac events:

http://content.onlinejacc.org/cgi/content/full/52/18/1482

The post by Charlie is very interesting and and informative; my personal opinion is that Beta Blockers are my least favorite BP medication due to all the side effects and, as his second doctor says, are overprescribed by overaggressive or panicked doctors...in my years of working with hypertensive individuals I have always suggested that they consult with their doctors to cover any possible alternatives to Beta Blockers and to seek a second opinion if it is not offered. The last article I posted and the development of the newer selective BB as you have mentioned seems to bear this out. Maybe we can both agree on that.

Back in 2008, I was placed on propranolol and it wasn't until I read this thread that I realized the negative affect it had on my hiking. In other words, I couldn't hike more that a few feet at high elevation without stopping for upwards of a minute to catch my breath. After reading this thread, I dropped propranolol after talking with my doctor.

Fast forward to today, I can hike 15 miles a day at high elevation without problems.

I want to thank this message board and all those who contributed to this fantastic discuss for your help in solving my problem.

This thread on blood pressure medication is important.

paul