Blood pressure and exercise

Your Heart Health in a Heartbeat – Episode 5

Document mentioned: 

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension


Hello everyone and thank you for joining me.

I’m Dr. Accad, medical director of Athletic Heart of San Francisco, and today I would like to talk about high blood pressure in relationship to exercise.  I am doing this in light of a document recently published jointly by the American College of Cardiology and American Heart Association that makes some recommendations for competitive athletes who have blood pressure concerns.

First, just to review what we discussed in the last episode, remember that the blood pressure is reported with 2 numbers, say, 130/70.  The top number is the pressure immediately after the heart squeezes, and the bottom number is the pressure when the heart is relaxed, before the next heartbeat.

Now, what happens to the blood pressure during exercise?  Well, that depends on the type of exercise performed.

For example, for static exercises such as weightlifting, both blood pressure numbers will go up—the top and the bottom numbers, and they can go up dramatically.  In fact, the highest recorded pressure during weight lifting was 480/350, which is really astronomical.  Now most weightlifters get away with it because the high pressure only lasts a few seconds.  Nevertheless, on rare occasions, weightlifting can cause acute damage to the wall of blood vessels, which can lead to very serious complications.  These complications, fortunately, are quite rare.  That said, there is some concerns that regular weightlifting may have more frequent long term complications, particularly in people who have high blood pressure to begin with.  In weightlifters and people who do a lot of static exercise, thickening of the heart muscle is seen more frequently than in non-weightlifters, and the thickening is in a different pattern compared to the type of thickening seen in endurance athletes, and may be less healthy.  For that reason, people who engage in weightlifting regularly and have blood pressure concerns may find it useful to undergo cardiac testing periodically to examine the health of the heart.

During aerobic exercise, however, the blood pressure increases but not nearly as much as it does during static exercise.  And what happens is that the top number typically goes up, because the heart is beating more vigorously, but the bottom number goes down a little bit because the blood vessels going to the muscle tend to dilate during aerobic exercise.  Typically, when someone is running and they start off with a blood pressure of 120/80, the blood pressure at peak exercise may be 170/70, or something like that, and return back to baseline within a few minutes.

Now, in some people, the rise in blood pressure during aerobic exercise is more pronounced.  The top number may go up to 200, 210 or even higher even though at rest the blood pressure may be normal.  What is the significance of such a rise in blood pressure during exercise?  Unfortunately there is not a great deal of certainty about it.  Studies have been a little bit conflicting: some show that in the long term, people who demonstrate a rise in blood pressure may be more likely to develop high blood pressure later on.  Other studies have not been so clear cut.

Now going back to the document published by the American College of Cardiology recently.  Is there anything new in there?  Three things have attracted my attention:

First, they say that people who have sustained high blood pressure and who which to engage in competitive sports should have a baseline echocardiogram to look at the size of the heart and thickness of the heart muscle.  I couldn’t agree more, and in fact, I would go further than that and add to that evaluation other tests as I mentioned in the previous video.

Second, they say that for those people who have an excessive rise in blood pressure during exercise, but a normal blood pressure at rest, we should consider using what is called a 24-hour blood pressure monitor.  That’s a machine that measures the blood pressure continually during a 24-48 hour period, to see if, on average and during day-to-day activities, the blood pressure is normal or if it is higher than we see when it is measured at rest in the office.

And third, they caution anyone whose blood pressure is not well controlled to refrain for competitive of very intense exercise activity, particularly weightlifting and static exercise, until the blood pressure is better controlled

I think these recommendations and the others they offer are reasonable and in line with what we are doing here at Athletic Heart SF, also I tend to approach things a little differently as I mentioned in my previous video.

I hope you have found this episode informative.  As always, the transcript of the show will be on the website of athleticheart SF.  Until next time, be well and be safe.