beta blockers and altitude

[GuyNC]

Hi all. I was recently diagnosed with fairly severe hypertension despite being fit and in otherwise good health. It is now well controlled with medication but one of the medications is the beta blocker carvedilol. I understand that beta blockers slow heart rate and reduce cardiac output to some degree so I am concerned about my upcoming trip to Mexico (Ixta, Orizaba) in January. I have noticed a very slight decrease in exercise stamina on hard training days so I expect the climbs will be a bit harder than they otherwise would. My concern is whether or not this effect is amplified at altitude or if I would be more susceptible to altitude sickness. My GP was not much help on this topic since altitude medicine is not his thing. I am interested in hearing the thoughts of the medical pros in the climbing community and the experience of other climbers on this or similar medications. Thanks!

[asmrz]

I had terrible time on them about 15 years ago. I would get winded so badly, I felt like another person in my body. They seemed to not only lower my heart beat, they also did not allow me to reach my maximum heart rate. After about three months when my climbing buddies carried my pack, waited for me at every turn of the trail and otherwise kept excusing my total loss of fitness, I simply told the doctor that anything that messes with my heart beat is unacceptable. We tested several different pills before I felt good again. I understand these things are highly individual, but if you don't feel good, there are about 150 pills to control BP. I never tested them at altitude, Sierra was about as high as I got that summer, but I had severe symptoms even as low as Mt Baldy here in Southern California

[Ben Beckerich]

My doctor wanted to put me on medication for high blood pressure, but I refused. I told him I'd cut salt and uptick my cardio instead, and about 8 months later my BP has actually gone down quite a bit. I'm now back into "pre-hypertension," as stupid a term as that is (shouldn't it be post-hypertension?). Side effect- I also climb WAY harder now, thanks to massive improvements in my cardio. I always focused so much on leg and arm strength, I never realized how bad I was shorting myself on cardio before. My resting heart rate is down around 40 and I fly at altitude, compared to before.

I know some guys have potentially deadly uncontrollable hypertension, and you gotta do what you gotta do... but if you haven't already, I would strongly consider any and all non- beta blocker options. Killing your cardio to improve your blood-pressure is like robbing peter to pay paul.

[Norris]

Ask your doctor if you could try a calcium channel blocker instead (time release Nifedipine). Nifedipine is a very effective blood pressure medication. In my view it is the optimal blood pressure medication for mountaineers, since it is a proven drug for not only treating but preventing HAPE.

[GuyNC]

Unfortunately I am well beyond what diet and lifestyle changes would be capable of fixing. Looking at my family history I assume it is probably a hereditary thing. The beta blocker is one part of a three drug combo (including a calcium channel blocker) that it took to get it down where it needs to be. I am at the lower end of the dosing range for the beta blocker so I hope the effect will not be as bad as asmrz experienced. If my BP stays stable where it is I will ask my doctor about reducing it further or maybe cutting it out completely. I will also mention Nifedipine. I have read about it being used to treat HAPE but I did not know is was also used for day to day BP maintenance.

Ben - I could not agree more about cardio fitness. I am new to climbing and mountaineering, getting into it just this past year. I thought I was in good shape after a couple decades of cycling, at times competitively, but my first experience at over 10k feet trudging up a snow slope on soft snow with a heavy pack was a bit of a shock. Cardio has been my main training focus ever since.

I appreciate the feedback.

[Foxy Long Bottoms]

"I would strongly consider any and all non- beta blocker options. Killing your cardio to improve your blood-pressure is like robbing peter to pay paul."

I couldn't agree more. When I take a beta blocker, its a real struggle to breathe. I'm also an asthmatic. The altitude isn't a factor for me. Taking the beta blocker and doing my thing at any altitude is brutal. I'd find another option.

[OPHIRTODD]

I'd cut to the chase and ask Dr. Peter Hackett. He runs the Institute for Altitude Medicine and they have an informative website:

http://www.altitudemedicine.org

The Institute provides high altitude consults for a nominal fee. Dr. Hackett is one of, if not THE foremost expert on altitude medicine here in the US. He'll give you the right beta, or, perhaps, beta blocker!

[Gimghoul]

I'd cut to the chase and ask Dr. Peter Hackett. He runs the Institute for Altitude Medicine and they have an informative website:

http://www.altitudemedicine.org

The Institute provides high altitude consults for a nominal fee. Dr. Hackett is one of, if not THE foremost expert on altitude medicine here in the US. He'll give you the right beta, or, perhaps, beta blocker!

If he's willing to give a formal consult for a small fee, this is good advice. I recommend you follow up with this.

I can't give you medical advice over the internet, but generally speaking the absolute risk reduction of good blood pressure control over a few week time period (such as that spent climbing at altitude) is negligible. Weighted over a 5 year period, it's still only a modest reduction in cardiovascular risk (100 people have to be treated for 5 years to prevent one heart attack). Over a few weeks? Unless a person has some specific conditions that requires them to be on a beta blocker, discontinuing BP medications for a few weeks is (again generally speaking for those with only asymptomatic hypertension and no other cardiac conditions) is a low risk proposition.

Follow up with your doctor and maybe see about a consult with Dr Hackett to figure out if the risk of being on the beta blocker outweighs its benefits to your health over a short period.