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Management of Hypertension in Actively Exercising Patients

Implications for Drug Selection

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Summary

In general, rises in systolic blood pressure to over 200mm Hg during exercise with a workload of 100W are regarded as pathological. Excessive exercise blood pressure values are to be expected in principle in all hypertensives. However, there are so far no generally accepted criteria for diagnosis of isolated systolic exercise hypertension (with normal values of resting blood pressure). The incidence of isolated systolic exercise hypertension is estimated to be about 10% of a selected population. In patients with excessive rises in blood pressure during exercise who want to engage actively in sport, general measures (reduction of obesity, restriction of alcohol and salt intake) and endurance training should be recommended initially. For endurance training, sporting activities that involve dynamic exercise are to be recommended (walking, running, mountain hiking, cycling, swimming, cross-country skiing). Activities involving isometric exercise (rowing, diving, tennis) and sport of a competitive nature are not suitable.

In moderately severe and severe hypertension (diastolic blood pressure values in excess of 105mm Hg), sporting activities and endurance training are contraindicated. If the exercise blood pressure values cannot be lowered below 220mm Hg with the general measures mentioned, pharmacotherapy is to be considered. The drugs of choice for suppressing excessive rises in blood pressure during exercise are β-blockers. In this group, β1-blockers are to be preferred to non-selective β-blockers because of the metabolic neutrality of the former. β-Blockers without intrinsic sympathomimetic activity (ISA) lower the blood pressure-pulse rate product more effectively than β-blockers with ISA. Alternatively, calcium antagonists of the verapamil type and ACE inhibitors can be employed. Diuretics, α1-blockers and calcium antagonists of the nifedipine type are less suitable for monotherapy, since they do not lower the systolic blood pressure-pulse rate product sufficiently during exercise. However, the latter substances can be used in combination with the former drugs.

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  1. Department of Internal Medicine, Community Hospital Dortmund, Beurhausstrasse 40, 4600, Dortmund 1, Federal Republic of Germany

    Dieter Klaus (Professor of Medicine)

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  1. Dieter Klaus
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Klaus, D. Management of Hypertension in Actively Exercising Patients. Drugs 37, 212–218 (1989). https://doi.org/10.2165/00003495-198937020-00008

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  • DOI: https://doi.org/10.2165/00003495-198937020-00008

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