Fifty Plus (50+) - Best blood pressure meds?

Well- this is my first posting in this forum, and I'm pissed with myself for needing to ask what I'm going to- cyclists are all invincible, right? And I haven't done a search, so I don't know if this has been kicked around before.

I'm 58, train as if I'm going to race (which I did in younger days), and am "pre-hypertensive". Since I eat right, exercise, don't smoke and all that stuff, the only baggage I had to toss overboard in an attempt to control the blood pressure with lifestyle related things was alcohol, which I consumed (mostly) moderately. That didn't do any good, and I haven't tried low salt since I eat mainly non-processed foods and don't use much salt. Nothing I did made any difference.

I let the doc convince me to use a low dose of lisinopril, which brought the readings down to nicely below "normal". It also made me cough, and my wife, who I tandem with, said that she felt I was more tired and not riding as strongly as I did before the med. To put it in her gentle terms, I wasn't the man she married.

I would guess that in the 50+ on this forum group there is a broad spectrum of experience with blood pressure medications, so I'm posting this query:

What is the best (or better at least) blood pressure medication to try if you want to avoid compromising athletic performance? I realize this is a matter of opinion, but I want to have the benefit hearing what others have experienced before I give in to what seems to be inevitable and go back to the doc for pills.

Thanks-

Rick

It is not so much a matter of opinion, as it is a matter of how your particular body chemistry reacts to the drug. Like you, I can not take ACE inhibitors, due to severe coughing. However, many folks do just fine on them. I take Diovan - Diovan is in a group of drugs called angiotensin II receptor antagonists. It works great for me, but is hard for others to tolerate.

If you haven't tried hydrochlorothiazide, it is generally considered the first drug of choice in the treatment of hypertension. If the doc hasn't tried you on this, ask him why not. It is cheap and effective.

There are 100's of BP meds - you may have to try a few.

Read this article regarding Hydrochlorothiazide (HCTZ);

http://www.ti.ubc.ca/pages/letter7.html

Drugs of Choice in the Treatment of Hypertension

Conclusion

Based on the evidence available at this time and using criteria of effectiveness and cost, thiazides are clearly the drug of first choice. Based on the criteria of efficacy, tolerability and convenience, thiazides are equivalent to or better than all other drugs. Therefore, thiazides are the drug of first choice for most uncomplicated hypertensive patients. There will be a proportion of patients (20-25%) where thiazides are proven ineffective or inappropriate. In these patients or in patients requiring more than one drug, other drugs must be substituted or added. These other drugs will be discussed in Therapeutics Letter 8.

Be aware that side effects may not show up for a long time. I had been taking monopril for years without problems. Then I began to sweat excessively in hot weather. Once I started, it just wouldn't stop. Sweat would be dripping off my hair. I complained to my doctor several times over a few summers, but he wasn't concerned. Then one day, I had an appointment with him when it was hot. One look at the sweating and he reviewed all my meds. A switch to Norvasc eliminated the problem. bk

For cycling, in my experience, the class of drugs lisinopril is from is by far the least likely to bother you when cycling. Many people do develop the dry cough though. In the early days of this class of drugs, the ACE inhibitors, doctors didn't know yet it was capable of having this effect. I suffered with this stupid cough for over a year, to the point that I traumatized my vocal chords. But nowadays, when that happens, the ACE inhibitors have a close cousin that is just as effective: the angiotensin II receptor blockers, which includes Cozaar, Diovan, Avapro, Micardis. Anyone of these would be a good choice for a cyclist, in my layman's opinion.

Studies and the small dose of thiazide diuretic? Ha! My high blood pressure laughed at that. Didn't even put a dent in it.

. A switch to Norvasc eliminated the problem. bk

And I can not tolerate Norvasc. Made my legs swell up like an elephant! We are all so different.

Meanwhile ... Motorad lurks in the shadows, soap box in hand, waiting for his opportunity to speak about lowering blood pressure ...

What is your cholesterol levels like, RickinFL? For a long time I was on the Atkins diet ... and the weight went down ... but my cholesterol went up. My wife, the Freulein from Diet-Hades, no longer stocks eggs and other really high cholesterol items in the house. I don't miss them much, but whenever I'm on business travel ... nobody had better get between me and my restaurant-cooked bacon & eggs ... I might knaw off a couple of their fingers trying to get to my eggs.

Significantly reducing my cholesterol intake has probably played a vital role in my overal low BP that I have now. I don't even take cholesterol medicine any more. Has your physician considered controlling your cholesterol ... as a secondary way to control your blood pressure?

I've been taking Lisinopril for so long that I can't remember when I started. If I have any side effects, I don't know what they are, except for maybe a very light morning cough that I don't even hardly notice. I'm just lucky, I guess.

I'm in my mid-50s. I'd been taking an ACE inhibitor and a beta blocker for over twenty years. Picked up biking two years ago. Quickly noticed issues with hill climbing--which I traced to the beta blocker. I've dropped enough weight that my physician suggested I stop the beta blocker. Now I take one 40 mg. tab of Lisinopril once a day. My BP five minues ago was 116/75. I'm not aware of any ill effects from the ACE inhibitor. Hill climbing has definitely improved without the beta blocker. I don't dread hills anymore. My advice is to stay away from beta blockers--but your physician is in the best position to judge your requirements.

Bob

Motorad-

I hadn't considered a cholesterol connection. I recently had blood work done in the course of a yearly physical, and the doctor didn't mention any issues with cholesterol, but then again, I didn't ask. Although I'd be surprised if it were high, I'll check.

Rick

I also find lisinopril works fine for me with no side effects. But as Dnvr says each person reacts differently to different drugs. If you have problems with a specific medication work with your physician and try different drugs in the same class or change the class of medication. There is enough variation that you should be able to find one that matches your physiology.

I am taking Benicar and do not detect any side effects. Probably my only real issue with taking BP medication is that I think it contributes to my having "Gray-out" effects (low BP) when I take breaks on long rides in hot weather. I tried to measure by BP after a self-supported century on a 100F day and couldn't get my BP tester to work. The numbers showing before erroring out were pretty low, but I was pretty trashed as well.

If I am resting and feeling low BP, everything returns to normal as soon as I get back on the bike and get going again. Since BP meds are generally not fast-acting, I haven't found a way to offset them on riding days.

My doc has me on Verapamil (calcium channel blocker). It noticeably reduces my cardiac response to exertion (heart rate won't come up) for over 12 hrs after taking it. She had me start taking it at bedtime, but I'm still not happy with it if I'm riding in the early morning. I can't recommend it to anyone concerned with athletic performance.

Although I'd be surprised if it were high, I'll check.

Rick
You never know. I have a tendency to ask my colleagues of their cholesterol levels, when we discuss blood pressure issues. Mine has been as high as 300, with the see-saw weighing more on the bad cholesterol than the good cholesterol.

Some people are pre-disposed to high cholesterol, some pre-disposed to high BP. Some like me have both issues side-by-side, with the sum of the two issues being higher than each issue added separately.

My cholesterol is currently around 185 I think, with the see-saw more balanced between good & bad cholesterol. I'm pretty sure this is a good factor why my BP now stays in a safe zone.

I would agree with other posts here. The ace-inhibitor worked for you with a side-effect of cough so switch over to an ace-blocker(angiotensin II antagonists are the appropriate name). Basically same overall effects without the cough as a side effect (cough side effect comes from a chemical known as bradykinin). Where the ace-inhibitor blocks the action of an enzyme in a pathway, an ace-inhibitor blocks it's action at the site of binding. Bottom line: no effect on bradykinin, no effect on cough. As mentioned above: Atacand , Cozaar, Diovan , Avapro, Micardis

Others have mentioned HCTZ as being first line therapy. This is true and i would typically recommend a switch to that however, you have past successful experience with an ace-i (lisinopril) so i would change my recommendation to stay within a similar class.

Look up RAAS (Renin Angiotensin-aldosterone system). If you look for a diagram of the pathways, you can see where ACE-I's work. They block the conversion of Angiotensin I to Angiotensin II.

I take HCTZ, then we added Lisinopril which I took for a year. I was in a mental daze for a year. Finally I connected it up with the Lisinopril, dropped it, and felt sharp and alert again. YMMV.

Why is it when it comes to blood pressure medicine, none of us ever take the same stuff, or is just my imagination? I take Norvasc and Toprol. But riding the bike has really helped in lowering my blood pressure overall.

Here's my story, and I'm sticking to it.

I started with Triamterene a few months ago, but during the followup my doc raised his eyebrows or wrinkled his brow or something, and changed the prescription to Lisinopril HCTZ. Now I'm also monitoring my blood pressure. I'm not noticing any drop in blood pressure yet, so my guess is the doc is going to try something else next time.

That said, I've had no side effects from either one.

Here's my story, and I'm sticking to it.


That said, I've had no side effects from either one.

You may not have noticed those side effects, but WE sure have:D

Well- this is my first posting in this forum, and I'm pissed with myself for needing to ask what I'm going to- cyclists are all invincible, right? And I haven't done a search, so I don't know if this has been kicked around before.

I'm 58, train as if I'm going to race (which I did in younger days), and am "pre-hypertensive". Since I eat right, exercise, don't smoke and all that stuff, the only baggage I had to toss overboard in an attempt to control the blood pressure with lifestyle related things was alcohol, which I consumed (mostly) moderately. That didn't do any good, and I haven't tried low salt since I eat mainly non-processed foods and don't use much salt. Nothing I did made any difference.

I let the doc convince me to use a low dose of lisinopril, which brought the readings down to nicely below "normal". It also made me cough, and my wife, who I tandem with, said that she felt I was more tired and not riding as strongly as I did before the med. To put it in her gentle terms, I wasn't the man she married.

I would guess that in the 50+ on this forum group there is a broad spectrum of experience with blood pressure medications, so I'm posting this query:

What is the best (or better at least) blood pressure medication to try if you want to avoid compromising athletic performance? I realize this is a matter of opinion, but I want to have the benefit hearing what others have experienced before I give in to what seems to be inevitable and go back to the doc for pills.

Thanks-

Rick
I stopped taking lisinopril because I felt that it was making me weak and tired all the time. My hill climbing was something to be desired. I now take "nifedipine" which I was very skeptical of taking since it is a calcium channel blocker. I knew that Calcium is required for muscels and I felt that it would make my legs weaker.
But it hasn't and actually my tiredness has went away and I now have a little more power on the pedals.
The same hills that I would huff and puff on in my 39-21/27 is easily attacked in my 39-17-19 with my recovery time cut in half. Even others have noticed the improvement over the pass two weeks.I feel "Nifedipine" has made a diffrence or it just may be the placebo effect. I will continue to give this a stuff a chance to see if there are any side effects. So far there are none. I feel normal and my BP is well into the normal range 115/75 - 119/71 and so on. Even my wife is happier, my drive is back:D
My goal is to get off meds completely and I think that if I continue to ride and loose weight like I have, then this may be possible soon. Good luck and listen to your doctor to stay safe.

I'd go either with an ACE inhibitor or blocker. If the inhibitor makes you cough, try a blocker - pretty much the same difference. If you are a real hard riding biker I'd tend to stay away from any of the thiazides or other diuretics like triamterene, etc., although in most people it probably wouldn't make much difference.
Some contend that beta blockers affects their exercise tolerance by slowing heart rate but given the PROPER dosage (Cardiac Output = Stroke Volume X Heart Rate) as stroke volume is increased it's a wash. That is, the heart rate is slower but the amount of blood pumped each beat is increased, so the net result on cardiac output isn't changed much. For the expensive heart monitor worshippers who feel they HAVE to exercise to a target heart rate, it could have a psychological effect, though. The main negative effect with beta blockers in my experience is mild depression. The ACES I think are better.
Sounds like you are doing everything right though, and normally I would have said train and get into shape an you can probably throw your antihypertensives away. So you might need a small dose of an ACE blocker.
Good luck on the racing.

Some contend that beta blockers affects their exercise tolerance by slowing heart rate but given the PROPER dosage (Cardiac Output = Stroke Volume X Heart Rate) as stroke volume is increased it's a wash. on cardiac output isn't changed much. Good luck on the racing.

Your formula is correct however you are missing the components that make up Stroke Volume thus the true reasoning B-Blockers affect Cardiac output. Stroke volume consists of 3 components: Preload, Afterload and contractility. B-blockers slow the heart rate but they ALSO decrease the force of contraction which affects contractility.

So take your above formula and you will find that b-blockers decrease both factors.

Rick, Digital, Denver, et al. Did a little google search and it lead to this old thread (ha, I'm a poet!) At 62.5 my bp suddenly went from the old standby 120/80 to 150+/80+. I saw my called my dr and started eliminating salt and stimulants (caffeine, chocolate, etc.) and coincidently lost about 10 lbs in preparing and training for the recent Horrible Hundred. My bp took a nice slide down toward normal and settled about 130/80 or so.

However, after thanksgiving in upstate NY (lots of eating and drinking and no riding) I put the 10 lbs back on and the BP has rose back up. I am back home and have not been able to ride as regular due to weather, work, holiday prep, etc. Although I've lost about 3.5 lbs, and been a lot better about avoiding salt and stimulants, my BP is seems to be rising. I have 3 months before my next follow up appt, but If the bp keeps rising, I'm going to let me dr know and he will probably proscribe a med.

I would prefer to avoid meds if possible, and so in addition to the steps above, I've started taking coQ10, niacin, and garlic tablets. I use a salt substitute as much as possible. However, in case I do have to go on to a med, I wanted to resurrect this thread and see how all your folks are doing 3 years later.

Looking forward to your commentary.

I am at about 120/80. I simply do not add salt to anything, period, nor do I use substitutes. There is plenty of salt in any canned or prepared food. No caffeine (however, that is for other reasons besides BP) or other stimulants. I continue with Diovan and HCTZ. If I go off of them, it will go up. The Diovan does not seem to bother me, and I have increased the HCTZ from 12.5 to 25mg per day, as I had a slight increase in the BP last year.

For cycling, in my experience, the class of drugs lisinopril is from is by far the least likely to bother you when cycling. Many people do develop the dry cough though. In the early days of this class of drugs, the ACE inhibitors, doctors didn't know yet it was capable of having this effect. I suffered with this stupid cough for over a year, to the point that I traumatized my vocal chords. But nowadays, when that happens, the ACE inhibitors have a close cousin that is just as effective: the angiotensin II receptor blockers, which includes Cozaar, Diovan, Avapro, Micardis. Anyone of these would be a good choice for a cyclist, in my layman's opinion.

Studies and the small dose of thiazide diuretic? Ha! My high blood pressure laughed at that. Didn't even put a dent in it.

I had that same coughing reaction to the first med my doctor prescribed, so he switched me right away to Diovan. I've been taking it daily for several years now without any ill effects that I can tell. It, along with diet and exercise, keep my average about 116/67. It does take a bit of work for me to get my heart rate up to where I like it during exercise (in the 130s), but I understand that can happen with most hypertension meds. But then my trainer admires how quickly it comes down and I recover, too. ;)

Diovan (Valsartan)

Lisinopril (40mg) and hydrochlorothiazide (12.5mg). As I understand it, the Lisinopril helps with the systolic pressure and the hydrocholorthiazide helps with the diastolic pressure. Also, as I understand it, the hyrdocholorthiazide helps decrease electrolytes. No ill effects from Lisinopril.

The hydrocholorthiazide gets me during the summer, because my electrolytes are low. After I started taking it, I would cramp on big, hot rides. Now, I take a Hammer Endurolyte as needed during a ride to keep from cramping.

When I initially started with Lisinipril I had a dry cough that I associated with allergies since I lived in the central valley in CA. Worst air quality in the country due to dust. Anyway, when I moved to Alabama a coworker suggested it may be the Lisinipril since her dad showed the same symptoms until they switched his meds. I asked my doc about it and he reduced the dosage, cough disappeared. My wife started lisinipril about 6 weeks ago, bam cough, and in a bad way. We talked to the doc, he changed her meds (can't remember off hand what it is) and the cough has all but subsided.

Hi Rick,

High BP is really nasty. It's like a mini Spanish Inquisition in which your body testifies against you for no clear reason. In my case, it cost me many thousands of dollars, as I could not fly for several months.

Do you monitor your BP? That's the best tool. Without it, the other tools don't work well. You may find that your PB is under control except when you are at the doctor's office. Relaxing after a ride home from work, I can always get it down to around 98/65 in a couple of tries. Put me in a doctor's office and it's hard to get below 150/80. My doctor maintains that a single measurement is meaningless, so get a good unit (my doctor recommends Omron), do it daily, and put it in a data base. Pick a criterion - average of 10, lowest value, highest value, whatever. The important thing is you have a consistant procedure and measure at the same times each day. I rest foor at least 10 minutes before taking a reading. My two year average of all readings is now at 112/70 and slowly going down.

There is no magic bullet for BP. In my case, the game is almost all mental. Slow breathing and relaxing thoughts bring it down better than anything. The mental part is 50 points, drugs are 20 points, exercise is 20 points, weight is maybe 10 points. Every time I have driven to the doctor's office, I get bad readings, so it is best to always ride. Driving a car is the most reliable way for me to shoot my BP up. Diet does nothing at all for me, possibly because I don't even have a salt shaker and don't like coffee. You have to do everything, because the effects are cumulative.

Unlike other sports, doping is legal and encouraged when playing the BP game. My doctor put me on 50 mg of Atelenol, a beta blocker. I commute by bike 20 miles every workday, and it does not give me any trouble. However, right before one physical, my doctor let me up the dose to see whether it would give me an edge going into the exam. Not so. At 75 mg, my stamina went away, but my BP was no lower than it had been at 50 mg. It's not a case of "some is good so more is better". Monitoring helps your doctor pick the optimum dope and dose level.

BP is all about monitoring and doctor-patient colaboration.

Paul