Andrew Siegel, MD Blog #111
I consider myself to be a very fit person—for the most part, I eat a very healthy diet with abundant fruits and vegetable and avoid processed, fast and junk foods, don’t smoke, drink alcohol very moderately, and exercise religiously and aggressively. I’m 5’9” tall and weigh 155 lbs., so I’m not carrying around much body fat. Nonetheless, in spite of my healthy lifestyle, I was diagnosed with hypertension this year. I am a strong believer in the mind-body connection and initially attributed my blood pressure issue to the incorporation of electronic medical records into my urology practice, a frustrating and tedious experience that has added hours of time to my workday and much grief and hassle to my life. That stated, it is difficult to hide from one’s genetics—I have a bunch of family members with high blood pressure, including my younger sister who is a vegetarian and avid cyclist and runner who truly could not be any leaner or in any better physical shape. But it really irks me that I know many obese and sedentary individuals who do not have blood pressure iss
Earlier this year, I was in Florida with my brother, cousin, and brother’s friend for an extended weekend golf and tennis excursion. We went to the Publix supermarket where we chanced upon one of those free blood pressure machines that you stick your arm in and presto, in a few moments you have a blood pressure reading. Suffice it to say that among the four of us, I lost the blood pressure contest! I wrote it off to the stressful week that I had had, but at a visit to my dentist several weeks later, the elevated blood pressure was confirmed. Suffice it to say that I was not pleased with this news.
You are probably aware that high pressure within the arterial walls (hypertension) contributes to many serious ailments including the following: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease. These cardiovascular diseases are the leading causes of death in the USA. So it behooves anyone with high blood pressure to get it treated, pronto.
I saw my internist and was prescribed medication called Diovan, which I started immediately. It controlled my blood pressure nicely, but I experienced some side effects, so I returned to my doctor and I recommended to him a trial of a different class of medication called a beta-blocker. This is typically not a first-line drug for hypertension and is often used for people with cardiac problems. It works by decreasing the heart rate and contractility (the ability of the heart muscle to squeeze out blood). This class of medication generally has a calming effect and I thought that because of my rather “energetic” style and persona, it might have a beneficial effect beyond managing the high blood pressure. Beta-blockers are sometimes used by people before public speaking, work on tremors of the hand, and have a general blunting/“take off the edge” effect. I have some early morning insomnia and thought that this might help with that as well.
The medication was effective in normalizing my blood pressure. However, it did “knock” me down a few notches. I experienced fatigue in the late afternoon that was new to me. More disturbing was that it was more difficult for me to exercise when it required major exertion. When working out, I became short of breath and tired much more readily than previously. I’m a recreational cyclist and have always enjoyed bike riding since my earliest days of childhood. I observed that I was having trouble keeping up with my cycling buddies and that hills—previously one of my strengths—were suddenly particularly difficult. Understand that I’m going to be 58 years old on my next birthday, so I thought that my age might have finally caught up with me a bit, but I also questioned what role the beta blocker was playing.
My old heart rate monitor that I typically use when I cycle was not working properly so I headed out to Campmor and picked up a new one. It is basically a chest strap that detects one’s heart rate that is displayed on a wristwatch. It is a very helpful device when cycling that helps one stay in the proper zone of heart rates to assure the appropriate level of exertion. For example, I know that my maximum heart rate is 160 and a level of 125–140 is a comfortable heart rate for an endurance ride. When I start heading above 145, I begin experiencing shortness of breath and need to tamp down the exertion if I want to maintain the endurance. I learned all of this when I attended Chris Carmichael hill cycling camp, located in Asheville North Carolina where I went a number of years ago with my cycling buddies to learn the proper techniques of attacking hills.
So I put on my new heart monitor and went out on a hilly ride. Much to my surprise, my maximum heart rate was now 125, being 160 under normal circumstances. At 115, I started experiencing shortness of breath; 110 was a comfortable rate. I was astonished by the profound effect the beta-blocker had my heart rate.
Understand that beta-blockers do not just work on heart rate but also on contractility. The term “stroke volume” refers to the amount of blood that the heart pumps out with one beat. Beta-blockers reduce both heart rate and stroke volume. The ability to succeed in aerobic sports such as cycling and running is contingent upon satisfactory cardiac output to provide oxygen and nutrients to our cells. Cardiac output is the product of heart rate and stroke volume. So, cardiac output goes way down on a beta-blocker and clearly explains my sub-normal performance with highly exertion physical sports.
I saw my internist yet again, stopped the beta-blocker, and started an alternative medication—the same one that my sister is on—that has no cardiac effects. I went on a bike ride in Fort Lee Park and Route 9W with my sister and friends and noticed a dramatic subjective improvement in my cycling performance, more in line with my typical cycling functioning of previous years. This was just one day after getting the beta-blocker out of my system. Objectively, my maximum heart rate was 140, much improved over the 125 on the beta-blocker, but still not up to the 160 that was typical for me. On my next ride, my maximum heart rate was back to normal and my cycling performance was fully back to days of old. I was back! I’m very happy to say that age is not catching up with me—yet.
Bottom Line: The morals of the story are several:
1. High blood pressure usually causes no symptoms whatsoever and must be sought after, so get your blood pressure checked periodically even if you’re feeling great
2. Do not assume that because you are in great physical shape, exercise regularly, are not overweight, are a non-smoker and have a healthy diet, that you are immune from high blood pressure, which is often genetic despite a very healthy lifestyle
3. Be wary of beta-blockers if you are an endurance exercise enthusiast. Apparently what I experienced does not happen to everybody, but it was quite profound with me.
4. Don’t tell your doctor what to prescribe you even if you are a doctor! Physician—do not treat thyself; let your internist provide their sage input regarding management of medical problems.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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