Creatine and Blood Pressure

Diet and Nutrition
21

[quote]teratos wrote:
Professor X wrote:
teratos wrote:
Your blood pressure is still too high. Current recommendations are BELOW 120/80. The lower the better. If you have a strong family history of heart disease, it is particularly important for you to keep it down. Fish oil can drop BP a bit, and will also improve your lipid profile. Flame Out is a good choice.

If you don’t do much cardio, consider adding it to your regimen. 30-45 minutes 4-5X a week. I know it can impact muscle growth, but that can be countered by consuming a protein drink immediately after aerobic exercise.

BTW, I am a hypertensive who takes creatine. I monitor my blood pressure closely, and saw no rise at all when adding creatine.

I am not sure where you got your standards from, but 120/80 is not “borderline high blood pressure”. That number is still closer to 145/95. They just INCREASED the line at which we can call patients as being hypertensive over a year ago.

Unless the military is operating under completely different standards, you are a little off. I don’t know anyone who would start worrying about someone’s blood pressure if they were highly active and simply read at 125/83.

The line was actually recently DECREASED. The JNC VII (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) is considered the “Ultimate Authority” on hypertension. Above 120 is now considered “pre-hypertensive”.

It is likely that they will decrease that again when the JNC VIII comes out.

Here is a link to an article about it on the American Heart Association page

I think, since I am hypertensive myself, and have a special interest in the pathophysiology and treatment of the disease, that I tend to be a bit more aggressive. I keep mine below 110/70. There is a direct relationship between the decrease in blood pressure and the decrease in heart attack/stroke. There is no point below which there is no further reduction in risk.

[/quote]

Agressive or not, I think it is a little off to think of things that strictly without the understanding of what the actual line for being hypertensive is. Body mass is also a factor. We don’t treat patients for “pre-hypertensiveness” and many people operate in a range above 120/80 without further problems.

Also, to be even more clear, the TOTAL patient is what one should look at, not just a flat guideline at which point you start sounding alarms. An athlete who walks in at 10% body fat and who does regaular cardio weighing over 230lbs with a blood pressure of 130/80 is NOT the same as a patient who is inactive and overweight at 230lbs with 30% body fat at the age of 45 with a blood pressure of 130/80.

22

I had 140 10 the last time I checked, but i’ve always had high bp, to me it’s like a stress thing I’m always anxious and on the edge

the doctor wanted me to start taking fludex and what not but I won’t

23

[quote]Professor X wrote:

Agressive or not, I think it is a little off to think of things that strictly without the understanding of what the actual line for being hypertensive is. Body mass is also a factor. We don’t treat patients for “pre-hypertensiveness” and many people operate in a range above 120/80 without further problems. [/quote]

You can also do just fine at 160/100 for 20 years or so, until you have a stroke. Body mass may have some effect on BP, but that doesn’t mean having an elevated blood pressure is OK to walk around with. There have not been studies done on the long-term effects of blood pressure in people with above average body mass.

Unless there was data showing such people tolerate elevated blood pressure better than people with normal body mass, it is better to err on the side of caution. If you review the extensive data on the association of BP with MI and stroke, and also the impact of treatment on those endpoints, it makes sense.

That being said, I don’t put people 130/85-90 or below on meds. Lifestyle modifications etc. should be given a fair shake. People above that should be treated. That is what the current guidelines say, and it is also what common sense dictates. There is clear line for being hypertensive.

“pre-hypertension” 120-139/80-89
Stage 1= 140-159/90-99
Stage 2= >159/>99

If you have a strong family history of cardiovascular disease, that can be considered a “compelling indication” and you can make a solid arguement for treatment with medication.

If you are interested, you can read a good synopsis of the JNC VII recommendations at:

I am asking this question because I truly am curious: Why are you so resistant to the idea of treating people at lower numbers when the data for reduction in morbidity and mortality is there?

I do enjoy your posts, Professor X, and I also enjoy discussions such as this one.

24

[quote]teratos wrote:
Professor X wrote:

Agressive or not, I think it is a little off to think of things that strictly without the understanding of what the actual line for being hypertensive is. Body mass is also a factor. We don’t treat patients for “pre-hypertensiveness” and many people operate in a range above 120/80 without further problems.

You can also do just fine at 160/100 for 20 years or so, until you have a stroke. Body mass may have some effect on BP, but that doesn’t mean having an elevated blood pressure is OK to walk around with. There have not been studies done on the long-term effects of blood pressure in people with above average body mass.

Unless there was data showing such people tolerate elevated blood pressure better than people with normal body mass, it is better to err on the side of caution. If you review the extensive data on the association of BP with MI and stroke, and also the impact of treatment on those endpoints, it makes sense. [/quote]

Are you actually understanding what I’m writing, or simply seeing what you want to see?

[quote]
That being said, I don’t put people 130/85-90 or below on meds. Lifestyle modifications etc. should be given a fair shake. People above that should be treated. That is what the current guidelines say, and it is also what common sense dictates. There is clear line for being hypertensive.[/quote]

Then why are you simply restating exactly what I wrote before? I wouldn’t have a patient medicated for “prehypertension” either if that was the only risk factor.

[quote]
“pre-hypertension” 120-139/80-89
Stage 1= 140-159/90-99
Stage 2= >159/>99

If you have a strong family history of cardiovascular disease, that can be considered a “compelling indication” and you can make a solid arguement for treatment with medication.

If you are interested, you can read a good synopsis of the JNC VII recommendations at:

I am asking this question because I truly am curious: Why are you so resistant to the idea of treating people at lower numbers when the data for reduction in morbidity and mortality is there?[/quote]

Did you read my last post? If you did, why do you think a distinction was made between the two patients? Did you think I wrote that for no reason?

25

Yep, read your post.

If you consider the available data, the athlete will have the same reduction in morbidity with reduction in BP as the non-athlete. Granted, he already has a lower risk than the non-athlete with the same blood pressure. If the athlete with 130/80 has done all he can to get it down, he should be on meds. He has stage 1 hypertension. Shouldn’t we do all we can to lower risk factors? My apologies for being redundant in the previous post, my fault for entering into a discussion when my mind isn’t processing well, I know it wastes your time.

I know I am all over the place right now…Up all night on call. Going to bed soon. I’ll re-enter the discussion when I have had some sleep.

26

[quote]Raziel wrote:

I had 140 10 the last time I checked, but i’ve always had high bp, to me it’s like a stress thing I’m always anxious and on the edge

the doctor wanted me to start taking fludex and what not but I won’t [/quote]

Why?

27

[quote]teratos wrote:
Yep, read your post.

If you consider the available data, the athlete will have the same reduction in morbidity with reduction in BP as the non-athlete. Granted, he already has a lower risk than the non-athlete with the same blood pressure. If the athlete with 130/80 had a strong family history of early heart disease, let’s say all the males in his family die by the age of 50, he may still be a candidate for drug treatment for his blood pressure, since he is in a higher risk category. (He may also be a candidate for cholesterol lowering medication as well). My apologies for being redundant in the previous post. [/quote]

I’m not going to argue from some “wellness” point of view because there is little info showing that people need to be medicated simply because they fall into a range of “prehypertension”. The entire patient needs to be looked at and the athlete in that range who is in good shape is at much less risk in my opinion than some sedentary person below 120/80 who smokes and thinks exercise is reaching for the remote. That is why the actual line at which someone is hypertensive is much more important to me, especially in terms of giving local aneshetic containing epinephrine which is one of my larger concerns. Again, my point is that falling at 125/81BP isn’t exactly a reason to start medication or concern. It is only one factor out of many that indicate how someone should be treated.

I did have one professor who basically believed that beta blockers should be pumped into the public water supply. I am not sure I agree with that.

28

because I didn’t like the doctor

I was 125 kilos and yeah that’s a lot but I was at 23-25% bf and he went to the chart and said ‘oh at 1,93m you should be 80 kilos… you are obese’

I was kinda shocked but eh I guess that’s the kinda doctors we have and that’s why I avoid them like the plague

29

teratos wrote:

I think, since I am hypertensive myself, and have a special interest in the pathophysiology and treatment of the disease, that I tend to be a bit more aggressive. I keep mine below 110/70.

[/quote]

Does lowering your blood preasure to this degree not have side effects like lethargy and weakness in the extremities

30

Anyone ever wonder how much the drug companies play a role in new hypertension categories? Seeing as how the lower the # the more people would be diagnosed, meaning more people on the medication.

31

[quote]jehovasfitness wrote:
Anyone ever wonder how much the drug companies play a role in new hypertension categories? Seeing as how the lower the # the more people would be diagnosed, meaning more people on the medication.[/quote]

That happens across the board.

32

[quote]jehovasfitness wrote:
Anyone ever wonder how much the drug companies play a role in new hypertension categories? Seeing as how the lower the # the more people would be diagnosed, meaning more people on the medication.[/quote]

In this situation, the data is there to support the reduction in heart attack, stroke and kidney failure. I am not a big fan of drug companies, and try to prescribe generics instead of the much more expensive brand names whenever possible.

There are tons of studies to support lowering BP as much as possible. Lowering BP 20/10 cuts your risk of coronary disease in half. These are not studies funded by any particular company.

33

[quote]Raziel wrote:
because I didn’t like the doctor

I was 125 kilos and yeah that’s a lot but I was at 23-25% bf and he went to the chart and said ‘oh at 1,93m you should be 80 kilos… you are obese’

I was kinda shocked but eh I guess that’s the kinda doctors we have and that’s why I avoid them like the plague[/quote]
Yeah, docs like that aren’t so great. You have to consider the whole patient. You have to toss the BMI charts out the window in athletes. You can’t say a 230 lbs. 6’1" bodybuilder is obese when he has 10% bodyfat. That is plain stupid.

34

[quote]Professor X wrote:
teratos wrote:
Yep, read your post.

If you consider the available data, the athlete will have the same reduction in morbidity with reduction in BP as the non-athlete. Granted, he already has a lower risk than the non-athlete with the same blood pressure. If the athlete with 130/80 had a strong family history of early heart disease, let’s say all the males in his family die by the age of 50, he may still be a candidate for drug treatment for his blood pressure, since he is in a higher risk category. (He may also be a candidate for cholesterol lowering medication as well). My apologies for being redundant in the previous post.

I’m not going to argue from some “wellness” point of view because there is little info showing that people need to be medicated simply because they fall into a range of “prehypertension”. The entire patient needs to be looked at and the athlete in that range who is in good shape is at much less risk in my opinion than some sedentary person below 120/80 who smokes and thinks exercise is reaching for the remote. That is why the actual line at which someone is hypertensive is much more important to me, especially in terms of giving local aneshetic containing epinephrine which is one of my larger concerns. Again, my point is that falling at 125/81BP isn’t exactly a reason to start medication or concern. It is only one factor out of many that indicate how someone should be treated.

I did have one professor who basically believed that beta blockers should be pumped into the public water supply. I am not sure I agree with that.[/quote]

OK, here is what I think. If you have a guy with a BP of say 130/90. He falls into the Stage 1 hypertension category. If there are improvements to be made, say he could lose some body fat, increase aerobic exercise etc., that should be done.

If you have a guy who is 7% bodyfat who does his share of aerobic exercise, and STILL has a BP in that range, you can do him a service by treating his BP. If you decrease his BP 20/10, you cut his risk of MI in half. That is an appreciable difference.

Even if his risk is relatively low, cutting his risk in half again is worth it. Recommendations are to start with HCTZ. It is in the ALLHAT trial. HCTZ is cheap and generic. Not really supported by any pharmaceutical company. Not too many side effects.

Seriously. If you can do something to cut your risk of MI in half, wouldn’t you? Even if it is relatively low to begin with, that is an appreciable difference.

I see you arguement about the athlete having a much lower risk than the guy who smokes and is sedentary. The sedentary smoker who is obese has a much greater risk of MI than the athlete who has the same blood pressure.

There have been no studies done looking at athletes with elevated blood pressure and assessing their risk of MI/stroke. In the absence of that data, I think it is still worthwhile saying the risk of MI/CVA is increased as the BP increases. Decreasing the BP should decrease the risk of MI/stroke. If I can cut this guys risk f MI in half, shouldn’t I?

35

[quote]teratos wrote:
Professor X wrote:
teratos wrote:
Yep, read your post.

If you consider the available data, the athlete will have the same reduction in morbidity with reduction in BP as the non-athlete. Granted, he already has a lower risk than the non-athlete with the same blood pressure. If the athlete with 130/80 had a strong family history of early heart disease, let’s say all the males in his family die by the age of 50, he may still be a candidate for drug treatment for his blood pressure, since he is in a higher risk category. (He may also be a candidate for cholesterol lowering medication as well). My apologies for being redundant in the previous post.

I’m not going to argue from some “wellness” point of view because there is little info showing that people need to be medicated simply because they fall into a range of “prehypertension”. The entire patient needs to be looked at and the athlete in that range who is in good shape is at much less risk in my opinion than some sedentary person below 120/80 who smokes and thinks exercise is reaching for the remote. That is why the actual line at which someone is hypertensive is much more important to me, especially in terms of giving local aneshetic containing epinephrine which is one of my larger concerns. Again, my point is that falling at 125/81BP isn’t exactly a reason to start medication or concern. It is only one factor out of many that indicate how someone should be treated.

I did have one professor who basically believed that beta blockers should be pumped into the public water supply. I am not sure I agree with that.

OK, here is what I think. If you have a guy with a BP of say 130/90. He falls into the Stage 1 hypertension category. If there are improvements to be made, say he could lose some body fat, increase aerobic exercise etc., that should be done. If you have a guy who is 7% bodyfat who does his share of aerobic exercise, and STILL has a BP in that range, you can do him a service by treating his BP. If you decrease his BP 20/10, you cut his risk of MI in half. That is an appreciable difference.

Even if his risk is relatively low, cutting his risk in half again is worth it. Recommendations are to start with HCTZ. It is in the ALLHAT trial. HCTZ is cheap and generic. Not really supported by any pharmaceutical company. Not too many side effects.

Seriously. If you can do something to cut your risk of MI in half, wouldn’t you?

[/quote]

A 90 diastolic is considered borderline. If I personally was treating someone, I would work on their activity level or diet first, not break out the prescription pad.

That is, of course, after taking their reading another two times to be sure that it isn’t just white coat syndrome. You seem precription happy. Ease up on that trigger finger.

36

Teratos you seem to keep your bp low, at what point do you start seeing issues like lethargy, lightheadedness and weakness in the extremities?

37

[quote]If you have a guy who is 7% bodyfat who does his share of aerobic exercise, and STILL has a BP in that range, you can do him a service by treating his BP. If you decrease his BP 20/10, you cut his risk of MI in half. That is an appreciable difference.

Even if his risk is relatively low, cutting his risk in half again is worth it. Recommendations are to start with HCTZ. It is in the ALLHAT trial. HCTZ is cheap and generic. Not really supported by any pharmaceutical company. Not too many side effects.

Seriously. If you can do something to cut your risk of MI in half, wouldn’t you? Even if it is relatively low to begin with, that is an appreciable difference.[/quote]

I’m no doctor, but I am curious. Besides, I can throw caution and good sense to the wind since I don’t have professional credentials to protect.

Do the studies out there showing a drop in risk take into account the fitness level of the individual at all, or are they instead across the general populace?

It’s a statement like this that would personally make me hesitate… Not too many side effects.

Also, what is the correlation between age and risk with increased blood pressure, and similarly is that differentiated between fit and sedentary individuals? Perhaps I could wait until I was older.

Finally, dropping by 50% sounds significant, but standing in for the prospective patient, what is the actual level of risk? Is it, say, dropping from .4% to .2% or something? Any numbers? I’d need to make an informed choice.

38

[quote]jdepron wrote:
Teratos you seem to keep your bp low, at what point do you start seeing issues like lethargy, lightheadedness and weakness in the extremities?[/quote]

I keep it about 110/70. I have the luxury of knowing what to do with my medications, and monitoring it closely. I have exercised off and on. More on over the past year. When I exercise, it makes a really big impact on my BP and I can thankfully cut back on my meds. I run into lethargy and weakness about 90-100/60. Anything above that and I am fine.

One of the other things that makes a difference is the medication I am on. Professor X mentioned beta-blockers. I find that these tend to kick my ass. Tired, poor exercise tolerance etc. Thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers aren’t so bad.

I find that 110/70
is acceptable for me. Lowers my risk of hypertension related problems while allowing me the energy to live an active lifestyle.

39

[quote]Professor X wrote:

A 90 diastolic is considered borderline. If I personally was treating someone, I would work on their activity level or diet first, not break out the prescription pad.

That is, of course, after taking their reading another two times to be sure that it isn’t just white coat syndrome. You seem precription happy. Ease up on that trigger finger.[/quote]

I think I haven’t made myself clear. I agree with exactly what you have said. You need multiple readings to make the diagnosis, first of all. I do that. I order 24 hour BP monitors often. More commonly, I have people check at home. White coat syndrome? OK, no need to treat…note in the chart that says “white coat syndrome”.

Lifestyle modifications are the most important first step. In younger people, we have plenty of time, so I can sometimes allot several YEARS to enact these. Increase aerobic and overall exercise. Fat loss. Sodium restriction when appropriate. The DASH diet (Dietary approach to stopping Hypertension) is effective for the people who will stick to it. Low fat dairy, fresh fruits and veggies, lean meats. I would much rather see people do it on their own than with a drug.

Pharmacologically, one of the first things I have people try is fish oil. It has been shown to modestly, lower BP, but the drop in BP is statistically significant. Flame Out could be considered an anti-hypertensive drug. You also get the secondary benefits of the impact on cholesterol and inflammation.

Beleive me, Professor X, I don’t break out the prescription pad lightly. The majority of people are slugs. You can talk until you are blue in the face about diet/exercise and they won’t do it. It is the rare person that does. I have a few success stories in this arena, but compared to the overall number of people who I have to treat with a drug, they are rarities.

There are people who have family history , or just genetic bad luck going against them. The guys who watch what they eat, exercise and STILL end up with high blood pressure. There is no data looking at athlete’s with high blood pressure in particular. We can surmise that the 35 year old guy who does everything right has a much lower risk of MI than the obese, smoking, cheese-steak eating fat guy with the same blood pressure elevation. However, studies consistently show that the lower the blood pressure, the lower the incidence of MI, stroke and all cause mortality. If I can cut someones risk of these in half, I think it is worthwhile. I also argue that with the correct agents, I can do it with no noticable side effects. If people will take Carbolin 19 or tribulis to increase muscle mass and training intensity, why isn’t a small dose of chlorthalidone a good idea?

It is rare that I see athletes who even have elevated BP. I treat my share of strenght athletes, as well as endurance athletes and I find that if the body fat is low, the blood pressure tends to be as well.

I also know from personal experience, that there are those with 10% bodyfat who, for genetic reasons, still have elevated BP. I feel it is prudent to treat once all non-pharmacologic means of lowering it have been exhausted.

40

[quote]
I’m no doctor, but I am curious. Besides, I can throw caution and good sense to the wind since I don’t have professional credentials to protect.

Do the studies out there showing a drop in risk take into account the fitness level of the individual at all, or are they instead across the general populace?

It’s a statement like this that would personally make me hesitate… Not too many side effects.

Also, what is the correlation between age and risk with increased blood pressure, and similarly is that differentiated between fit and sedentary individuals? Perhaps I could wait until I was older.

Finally, dropping by 50% sounds significant, but standing in for the prospective patient, what is the actual level of risk? Is it, say, dropping from .4% to .2% or something? Any numbers? I’d need to make an informed choice.[/quote]

Exercise imparts a 35% lower risk of cardiovascular events over your sedentary counterparts. If you search hypertension + athlete you will not find a heck of a lot of good data. What you will find are recommendations for lifestyle modifications where possible, and treatment per the current guidelines for hypertension.

There are formulae for calcuating your risk of a cardiovascular event rate. They are based on age, sex, smoking, blood pressure etc.

It would be nice if there were data looking at athletes, in particular, on a large scale, but it just isn’t there. Once you have exhauseted all lifestyle modifications, you need to consider pharmacologic treatment. What is an acceptable risk to you? If you are fairly young, with good cholesterol, don’t smoke, but have an elevated blood pressure, your risk is less than 1%. Blood pressure does its damage over time, so the longer you have it, the more apt you are to have problems. If you can cut your risk from 0.4% to 0.2% with the addition of a drug that has few , if any, side effects would you?

Play with the calcualtor. I entered my current stats, but put in what my BP would be UNTREATED. At age 35, my risk of having a CV event is less than 1%. At age 50, with the same cholesterol and untreated BP, my risk is 3%. That’s a lot. The effects of BP are cumulative. If I can keep that pressure down over time, I can lessen my risk. I’d rather do that.

I put the phrase “not too many side effects” in because no drug treatment is without side effects. In most cases, if you choose the right agent, there will not be any side effects. Thiazide diuretics, ACE inhibitors, are good first line agents without many problems. You do need to make an informed decision. Do some research, learn about the disease, the implications of treatment vs non-treatment.