Managing hypertension in athletes and physically active patients

Athletes and other physically active patients should be screened for hypertension and given appropriate therapy if needed. Mild hypertension should be treated with non-pharmacologic measures for six months. If blood pressure control is adequate, lifestyle modifications are continued. If control is inadequate, low-dose therapy with an angiotensin-converting enzyme inhibitor or a calcium channel blocker may be started. A thiazide diuretic may be used as first-line treatment for hypertension in casually active patients; however, diuretic therapy is less desirable in high-intensity or endurance athletes because of the risk of hypovolemia or hypokalemia. If beta blockade is needed, a combined alpha-beta blocker may be the best choice. When the target blood pressure is achieved, long-term follow-up care and management should be emphasized. If excellent control is maintained for six to 12 months, medication may be reduced or withdrawn in a small number of patients. If the target blood pressure is not achieved, the medication dosage may be adjusted, or a second medication, usually a diuretic, may be added. Physicians need to be aware of the effects of various medications on exercise tolerance and the rules for participation established by sports regulatory bodies (Am Fam Physician 2002;66:457-8).