From the Guidelines
Athletes with stage 2 hypertension should be restricted from high static sports, such as weight lifting, until hypertension is controlled by either lifestyle modification or drug therapy. During acute weight lifting, blood pressure increases significantly due to the Valsalva maneuver and muscle contraction that compresses blood vessels, increasing peripheral resistance 1. This acute elevation in blood pressure can be particularly concerning for individuals with pre-existing hypertension.
Key Considerations
- Both systolic and diastolic blood pressure rise during resistance exercise, including weight lifting 1.
- It is reasonable that athletes with stage 2 hypertension should have their blood pressure controlled before participating in high static sports like weight lifting 1.
- Individuals with hypertension should undergo careful assessment of blood pressure and may need to modify their exercise approach, such as using lighter weights and avoiding exercises that cause extreme pressure increases 1.
Recommendations for Athletes with Hypertension
- Athletes with stage 1 hypertension can participate in competitive sports without restriction, but their blood pressure should be monitored every 2 to 4 months 1.
- Those with prehypertension should be encouraged to modify their lifestyles but should not be restricted from physical activity 1.
- Athletes with sustained hypertension should have screening echocardiography performed, and those with left ventricular hypertrophy (LVH) beyond that seen with “athlete’s heart” should limit participation until blood pressure is normalized by appropriate antihypertensive drug therapy 1.
From the Research
Blood Pressure During Acute Weight Lifting
- Blood pressure responses during exercise were similar among all subjects in a study on the vascular benefits of aerobic compared with resistance exercise 2.
- The study found that brachial artery flow-mediated vasodilation (FMD) improved in conditioned weight lifters and runners after acute hypertension, but decreased in sedentary subjects 2.
- Another study recorded the blood pressure response to heavy weight-lifting exercise in experienced body builders, finding that systolic and diastolic blood pressures rose rapidly to extremely high values during the concentric contraction phase for each lift 3.
- Peak pressures during the double-leg press exercise reached a mean group value of 320/250 mmHg, with pressures in one subject exceeding 480/350 mmHg 3.
- The American Heart Association recommends lifestyle approaches, including physical activity, as first-line treatment for elevated blood pressure or cholesterol, highlighting the benefits of increasing physical activity in improving blood pressure and blood cholesterol 4.
Factors Affecting Blood Pressure During Weight Lifting
- The Valsalva maneuver, which involves expiring against a closed glottis, can contribute to the increase in blood pressure during weight lifting 3.
- Mouth pressures of 30-50 Torr during a single maximum lift, or as subjects approached failure with a submaximal weight, indicate that a portion of the observed increase in blood pressure was caused by a Valsalva maneuver 3.
- Calcium channel blockers, which dilate arteries by reducing calcium flux into cells, can effectively lower blood pressure, especially in combination with other drugs 5.
Implications for Blood Pressure Management
- Resistance and aerobic exercise may confer similar protection against acute vascular insults such as exertional hypertension 2.
- The effectiveness and safety of antihypertensive medications, including beta-blockers, calcium channel blockers, and angiotensin receptor blockers, have been assessed in various studies, with no significant differences in efficacy found between these medications 6.
- Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with mild-moderate-risk blood pressure and cholesterol 4.