Hello Drs!
I wrote you guys a while back with some other questions and you were very helpful. So I’m back with another because I am interested in your opinion related to strength training. I’m 42 6’2" and 338lbs. I have been working on myself for just under 2 years now and I am down over 125lbs. I’m sure others have done it faster, but I’m really happy with my progress even if it is slow and steady because everything I’m doing is so easy to stick to, even on vacations or work trips. I absolutely love strength training. I do a 4day heavy/light split with walking/running 3 days a week (and walking even on some lifting days). I have a hypothyroid condition which is under control with medication. I wear a CPAP machine religiously. I easily get 8-9 hours sleep every night. I am on testosterone replacement therapy for the last 2 years. I have a great relationship with my PCP. At my last physical this month, my BP was rather high. I had come to his office immediately from the gym (I did shower, but that is all). I don’t how long Preworkout, plus squats and deads cause BP to rise and stay risen after a workout. He did test a second time at the end of my visit. It was lower at something like 160/82. He still wasn’t thrilled with that number. We made an appointment to check it again in 2 weeks. I made the appointment for before any kind of training. I’m not a dummy though. I understand that even though I’ve lost a lot of weight, I can still have high BP because I’m still considered obese. I can keep working on reducing my body fat and increasing my conditioning, but that takes time so there is a real chance I am hypertensive. He said we may need to have a discussion about BP medications. I’m ok with that. I want to make sure I’m not going to die from high BP. My question for you both is, are there better medications for people who like lifting than others? I know there are a slew of medications out there that work different ways. Some of the ways seem counterproductive for strength training. He knows I lift, and he’s a younger doc who was a collegiate wrestler so I think he’d be willing to prescribe the right kinds of meds to not hinder things, but you never know. I’ve had co-workers who have “doctors orders” to only lift light from now on. So based on the info I’ve given, is there a direction that is better than others as far as treatment? Are there any meds that are ones I could never come off of even if I lose another 75-100lbs? Lastly, are there other options that might be off label that would still work? I’ve heard daily Tadalafil can lower BP because it is a vasodilator. I’d be happy with an option like that because of the bedroom perks 
Thank you for reading through it all. It might not even be a real issue, but I’m realistic and if it is, I’d like to be prepared if we have that discussion.
-someguy
Hey there,
Congratulations on your progress so far, really impressive work and I hope you continue on and reach your goals.
These are good questions - it is interesting (and would be a bit unusual) for you to have NOT had high blood pressure when you were heavier, and to have developed it now, in the middle of a rather dramatic weight loss. I certainly think it is a good idea to re-check it at a later time, away from training, as that seems like it could be an issue here.
But if not, I’d be re-evaluating to see whether there’s anything else that could be driving the high blood pressure, rather than just chalking it up to body fat given the timing of this. This could include re-evaluating your current dose of TRT, your thyroid hormone levels, your CPAP data, NSAID/alcohol/other supplement use, and a few other things.
When it comes to medications, the main ones I’d avoid in this situation would be beta blockers, and I probably wouldn’t use a diuretic as my first choice for someone who trains regularly or who is an athlete (although I wouldn’t rule out its potential use down the line, if needed). I’d probably start with an ACE inhibitor or angiotensin receptor blocker (ARB) first in this situation for most patients, unless I had a good reason to avoid them or to start another agent like a calcium channel blocker or a diuretic. Any use of off-label agents would be a discussion to have with your doctor – I can’t say I’ve prescribed tadalafil for high blood pressure myself, and if your BP is indeed 160 systolic, that wouldn’t be anywhere near enough to get you to the targets.
Seeing this question, and the response from Austin in particular, piqued my interest…
“When it comes to medications, the main ones I’d avoid in this situation would be beta blockers, and I probably wouldn’t use a diuretic as my first choice for someone who trains regularly or who is an athlete (although I wouldn’t rule out its potential use down the line, if needed). I’d probably start with an ACE inhibitor or angiotensin receptor blocker (ARB) first in this situation for most patients, unless I had a good reason to avoid them or to start another agent like a calcium channel blocker…”
As part of my medication protocol for my kidney transplant I am on a calcium channel blocked (nifedipine). Should there be any concerns from a training (and also sprinting and general intense activity) standpoint?
Through the years prior to Dx and Tx I’ve gone through a range of different BP medications, including various ACE inhibitors and beta blockers, and certainly the beta blocker I took whilst at university had the most noticeable effect when trying to train, to the extent that I stopped training and playing football (soccer) for a few months because I was getting so light-headed and dizzy.
Thank you so much Dr. Baraki. I am hoping it wasn’t anything more than just being “up” from my lift. I bought an Omron BP5450 because Consumer Reports rated it the best regarding accuracy. I plan to check my BP when I wake up and once or twice throughout the day to see how it reads. This AM it was 129/78 so I am hoping BP meds is not an avenue I have to go down. I’ll be sure to let you know what does happen in 2 weeks though. Thank you for the kind words regarding my weightloss journey.
-someguy