High blood pressure is very common in the general population and also in runners.

Howdy Doc,

I’m 43 and have been running for 20 years. I have a generally healthy lifestyle, but my blood pressure is getting to the point where I’ll probably need medication. I have no other medical issues. I am 5’9″ and weigh 163 lbs. I’ve been running 20-25 miles/week for the past 20 years at an 8-9 minute pace. I have not run marathons, but have completed many half marathons and 10Ks. My training includes occasional speedwork, hill running, and long runs (10-15 milers). I don’t smoke or drink and never have. There is no strong family pattern of hypertension (some on mother’s side, but not overwhelming). I eat a decent diet, with an emphasis on greens and fruits and a de-emphasis on processed foods. My sodium intake was probably not ideal for most of my life (but not crazy high). Luckily, I have no biomechanical issues.

I understand that when it comes to overall health, running isn’t a panacea. But I’m surprised that two decades of running 20-25 miles per week isn’t improving my blood pressure. Lately, when I discuss the situation with a doctor, I usually hear “no big deal, high BP is common, here’s a pill. Off you go!” That’s frustrating because I’d love to get some medical expertise about why regular exercise isn’t helping my BP. Is hypertension a common problem for runners/athletes?

Thanks, Doc. All the best!

Matt — Boston, MA

Dear Matt,

Hypertension or high blood pressure is very common in the general population and also in runners. Although it is frustrating to exercise regularly and still have an elevated blood pressure, it is often tied to genetic factors that we cannot control. I usually suggest to my patients that their great lifestyle has postponed the need for medication, but at some point it is better to be on medication than to incur the consequences of persistently elevated blood pressure on the end organs like the blood vessels, heart, brain, kidneys, and eyes.

Exercise alone can drop the blood pressure 10 or so mm Hg in most people. If you are genetically programed for high blood pressure, this may not be enough to protect the pressure sensitive tissues. From my personal experience over the past 2 years, I noted that with prolonged inactivity as a result of a knee injury, arthritis flair, and two joint replacements my blood pressure drifted up 10-20 mm Hg and now that I am back to regular aerobic exercise (in-line skating and biking), my blood pressure has dropped back to near my pre-injury levels.

It may be time for you to consider medication. Be sure to let your physician know that you are an active runner so you can help choose the medication that best suits you. Some medications like beta blockers slow your heart rate and make it harder to exercise comfortably; others can disturb electrolyte and water balance and potentially cause problems in the heat. I tend to start with ACE inhibitors or alpha blockers, but each patient has individual needs that make a blanket recommendation difficult. Your physician should be able to help you navigate the maze of medications, risks, and benefits.

A true love for sports

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