The Silent Killer in BodyBuilding

As much as I know John loves the idea of being a ninja, the last thing we want to see is more bodybuilders dying from the silent killer of blood pressure.

We know that over the long term, a lot of bodybuilders who have mismanaged their health markers, especially blood pressure, end up dying from heart and/or kidney issues that stem from chronic exposure to high blood pressure across their bodybuilding careers.

In fact, some data out of the University of Copenhagen showed “compared with the former abusers and the controls, the ongoing abusers’ average day and night BPs were significantly higher.”(Rasmussen)

Knowing this, making an effort to manage blood pressures for ourselves and our clientele is an important aspect to manage alongside a practitioner in order to get the best long term health outcomes for our clientele.

Well we know we need to manage it, but how do blood pressure medications fit into our management systems?

To start, we may need to look at what blood pressure medication options we have, how the work, and what typically causes blood pressure elevation in bodybuilders?

For the classes of blood pressure medications, we have 4 main ones that are the most common to use and how they lower blood pressure below: 

1. Angiotensin Receptor Blockers (ARB’s)/Angiotensin Converting Enzyme (ACE) Inhibitors: These act via angiotensin inhibition to lower blood pressure. 
2. Diuretics: Increased sodium/water excretion to lower blood volume and lower blood pressure. 
3. Beta-blockers: Lower the effects of epinephrine it lowers the speed and force at which the heart beats to lower blood pressure. 
4. Calcium Channel Blockers: Blocks calcium from entering the cells of heart and arteries to relax and open blood vessels, and in turn, lower blood pressure. 

When we look at PED usage effects on the cardiovascular system, we see that PED’s negative effects are often mediated via the renin-angiotensin-aldosterone-system (RAAS).

”Testosterone can increase renal artery BP probably via potentiating the renin-angiotensin-aldosterone system…promoting water and sodium reabsorption” (Davani-Davari).

We can further look into this net influence of androgens on RAAS into oxidative stress, inflammatory cytokines, and even apoptosis that leads to kidney fibrosis, however, the line of logic above is where most people will typically go towards ARBs or ACE Inhibitors.

Logically, this would make the most sense to influence blood pressure here as this is where PED’s have the greatest influence in elevating blood pressure.  

For some people, however, using one class of drug (monotherapy) will not be enough to bring blood pressure down to the blood pressure targets we should be aiming for.

This is where dual therapy can be very beneficial.

In fact, we have data that shows the efficacy of dual therapy over monotherapy with Telmisartan and Amlodipine (calcium channel blocker) to support this line of thought as well (Guthrie).

Ultimately, the goal should be to manage blood pressure as needed to maintain good blood pressure ranges that will limit the risk over the long term for cardiovascular and kidney health to keep us bodybuilding for longer.

Work with your cardiologists and coach to find the right medications for you in order to manage your blood pressure values, and ultimately live a longer, healthier life.

Citations

1. Rasmussen JJ, Schou M, Madsen PL, Selmer C, Johansen ML, Hovind P, Ulriksen PS, Faber J, Gustafsson F, Kistorp C. Increased blood pressure and aortic stiffness among abusers of anabolic androgenic steroids: potential effect of suppressed natriuretic peptides in plasma? J Hypertens. 2018 Feb;36(2):277-285. doi: 10.1097/HJH.0000000000001546. PMID: 28863033.
2. Davani-Davari D, Karimzadeh I, Khalili H. The potential effects of anabolic-androgenic steroids and growth hormone as commonly used sport supplements on the kidney: a systematic review. BMC Nephrol. 2019 May 31;20(1):198. doi: 10.1186/s12882-019-1384-0. PMID: 31151420; PMCID: PMC6545019.
3. Guthrie RM. Review: a single-pill combination of telmisartan plus amlodipine for the treatment of hypertension. Postgrad Med. 2011 Nov;123(6):58-65. doi: 10.3810/pgm.2011.11.2495. PMID: 22104454.

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