THE CLINIC: Hypertension Drugs and Warning Athletic Performance

QUESTION:

I have been taking the blood pressure medication atenolol for a few years.

Since I started taking the drug my running has gone downhill.  In the past

I have run 13 marathons; now if I run more than three miles I get fatigued.

I have continued to gain weight and it has been difficult to lose it.  I

have read about atenolol potentially causing weight gain and fatigue among other things.  

Have other runners experienced this with atenolol and is there a substitute

medication that does not have these side effects?

 

Dave Calhoun

Devon, NH

 

ANSWER:

There are essentially four classes of medications that can be used as

first-line agents for the treatment of high blood pressure:  beta blockers,

calcium channel blockers, diuretics, and angiotensin converting enzyme (ACE)

inhibitors/angiotensin receptor blockers (ARBs).   In general any of these

classes of medications represents a reasonable choice for the treatment of

hypertension.   A certain agent may have more benefit in an individual

depending on additional characteristics of that patient.  For instance, beta

blockers have additional benefits in patients who also have had a heart

attack or heart failure, calcium channel blockers in patients with angina,

diuretics in patients with ankle swelling, and ACE inhibitors/ARBs in

diabetics.  One agent may also be more effective than another based on

patient demographics (age and race).   Cost may also influence medication

selection (in general generic beta blockers and diuretics are cheaper than

calcium channel blockers and ARBs).

 

Atenolol is a beta blocker.  It can cause the side effects that you mention.

Beta blockers generally do not impair performance in people engaged in

moderate (leisure) physical activity, but many athletes performing at a

higher level find the side effects to be intolerable and to have a negative

impact on athletic performance.   

 

From a biochemistry standpoint, beta

receptors exist in the heart and blood vessels as well as in other tissues

throughout the body.  Stimulation of the beta receptors with chemical

substances like adrenaline that get released during exercise cause the heart

to beat faster and stronger (more forcefully).  Beta blockers bind to these

beta receptors, thereby partially blocking the effects of adrenaline,

resulting in a slower heart rate and less forceful contraction of the heart

muscle.  These effects are desirable in someone who has had a heart attack

but are undesirable during athletic competition since maximal cardiac

performance (and hence athletic performance) depends on the increase in

heart rate and increase in contractility of the heart muscle during

exercise.

 

You should never stop any blood pressure medication on your own.  This

caveat is especially true with beta blockers, since these medications may

need to be gradually tapered rather than abruptly terminated when

discontinuing.   I would suggest that you discuss with your physician the

side effects that you have noticed and the possibility of changing from

atenolol to a different class of medication.   With the large number of

blood pressure medications that are currently on the market, it is usually

possible to find an effective medication or combination that controls blood

pressure adequately with minor or no side effects.

 

Beta blockers are the class of medication that stand out as being not well

tolerated in athletes.  The other three classes are pretty much a toss-up.

Theoretically athletes might want to avoid diuretics if training/running in

hot weather as diuretics could predispose towards dehydration.   I would

lean towards using an ACE-inhibitor/ARB or calcium channel blocker,

especially if you are still doing marathons.  The major disadvantage is cost but

there are generic ACE-inhibitors and calcium channel blockers on the market,

which helps.

 

Todd Miller MD

Rochester, NY 

 

 

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(RUNNING & FITNEWS^® September/October  2008• Volume 26, Number 5)