Athletes and other physically active patients are usually thought to be free of cardiovascular disease and hypertension because of their apparently high level of fitness. Indeed, the overall prevalence of high blood pressure in these groups is approximately 50 percent lower than in the general population.
Preferred medical therapies for athletes include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and long-acting dihydropyridine calcium channel blockers; second-line therapies best avoided in athletes include diuretics and beta blockers.
You may think that athletes are in the best of health. However, almost half of American adults struggle with high blood pressure, according to the American Heart Association (AHA). And studies suggest athletes are not necessarily exempt.
What's High Blood Pressure?
For athletes and non-athletes alike, blood pressure is considered "normal" when the upper (systolic) number remains under 120 millimeters of mercury and is paired with a lower (diastolic) number that comes in under 80, according to the AHA.
When the upper number falls between 120 and 129, however, an individual's blood pressure is considered "elevated," even if the diastolic number remains below 80. And when the upper number is above 130 and is combined with a lower number that exceeds 80, you've entered the realm of "high" blood pressure.
Blood Pressure Risk for Athletes
According to a June 2015 study in the British Journal of Sports Medicine (BJSM), high blood pressure risk among athletes can vary considerably, depending on the type and intensity of their training.
The analysis included more than 138,000 strength- and endurance-focused male and female athletes, 18 to 40 years old, representing a wide range of sports backgrounds, from soccer and football players to triathletes and long-distance runners.
The study concluded that strength-trained athletes have significantly higher blood pressure than endurance-trained athletes. It also found that vigorous physical activity did not reduce the athletes' blood pressure, when compared with non-athletes.
That finding does not come as much of a surprise to Willie E. Lawrence Jr., MD, chief of cardiology at the Research Medical Center at Midwest Heart & Vascular Specialists in Kansas City, Missouri. "Generally speaking, athletes are going to be healthier than nonathletic folks," says Dr. Lawrence.
But, with respect to high blood pressure risk, "It's tricky," he says. "It really just depends. If you're talking about big football players, they may well be tremendous athletes, but they also may have higher rates of high blood pressure and diabetes than other types of endurance athletes, like runners."
"Certainly being an athlete in and of itself is not going to prevent you from having high blood pressure," he says. "It's actually a common concern among athletes." The treatment for athletes, Dr. Lawrence says, would be the same treatment that anyone with high blood pressure would pursue.
Medications are one option. Called "antihypertensive," the AHA lists diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, alpha blockers, central agonist and vasodilators as possible choices.
Exercise and Blood Pressure
Despite the BJSM findings regarding high blood pressure in athletes, experts agree that the average person with high blood pressure could probably benefit considerably by incorporating more exercise into his or her daily routine.
According to the Mayo Clinic, people who have overweight or obesity often see their blood pressure rise. That excess weight can also interfere with proper sleep — which can also drive up blood pressure — particularly when a man's waist circumference exceeds 40 inches or a woman's 35 inches.
But for non-athletes whose routines tend toward couch-potato status, getting active and losing even a small amount of belly weight can help. In fact, the Mayo Clinic points out that, for every 2.2 pounds of excess weight lost, your blood pressure is likely to drop by roughly 1 millimeter of mercury.
For overall wellness (not to mention a lower blood pressure and possibly a slimmer waistline), the AHA advocates embarking on a regular program of moderate-intensity physical activity — to include such activities as walking briskly, climbing stairs, biking, swimming and more — for a total of about 2 1/2 hours a week, which can be broken up into, for example, half-hour sessions across at least five days.
A minimum of two days a week of muscle-strengthening activities, as well as pacing it over a period of time, is also recommended. But if you're new to exercise, the AHA advises that you consult with your doctor first to prevent injury and ensure that you don't bite off more than you can chew.