THE CLINIC: Timing BP Med Intake During Long Distance Training

Thu, 13 Sept. 2012 - 2:07 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I have been taking 25 mg of Atelnolol and 12.5 mg of Hydrochlorothiazide to control my blood pressure. I started this medication about one year ago. My blood pressure is usually 120-130/65-75 when I am on the medications. I am currently training for a marathon and take these medications after my morning run. Is this the right time to take them? Or should I take them before I run? 
 
Dale Ledbetter
Colorado Springs, CO
 
ANSWER:
The most important issue concerning treatment of hypertension is whether or not you take the medication at all—which you are doing. All other issues, such as when you take the medication, are much less important.
 
That said, these medications are generally prescribed so that their maximal effectiveness occurs when a person’s blood pressure is highest. As a result, most people take their blood pressure medication first thing in the morning so that the greatest effect will occur during daytime hours, when they are most active. In your case, it might make sense to take your medication an hour or so before you run since your blood pressure is likely to be higher during your training. However, my reasons for suggesting this are more theoretical than proven fact, so if taking your medication before your run would be inconvenient, I don’t see any real reason to change.
 
Todd Miller, MD
Rochester, MN
 
ANSWER:
It’s important to have a proper potassium and magnesium balance before you run, which can be reduced with the diuretic. Keep this in mind if you take it beforehand. In addition, it is important that you stay well hydrated both during and after the run to avoid dehydration and low blood pressure.
 
The Atenolol has a long half-life and may provide blood pressure control for nearly 24 hours. If you don’t take it before you run, you may get more out of training because your heart rate may be less “blocked” by the medication. However, this also may cause your blood pressure to be too high on your runs. Since you are training for a marathon, I would advise an exercise test to assess blood pressure control under aerobic stress.
 
Lloyd Lense, MD
Old Field, NY
 
ANSWER:
ACE inhibitors may not adversely affect exercise performance at all or in the same way that a Beta blocker like Atenolol does, which would allow you to take the medication without regard for your training. Perhaps you could revisit your doctor and see if a change in hypertension medicine is possible.
 
Melvin Williams, PhD
Norfolk, VA

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(RUNNING & FITNEWS® January / February 2009 • Volume 27, Number 1)



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