High Blood Pressure Tips & Treatments : Exercise for High Blood Pressure
Sports
I have always done a lot of sports. Now that I have been diagnosed with high BP, are there any sports that are particularly good or bad for me?
Scuba diving may be dangerous for anyone either with uncontrolled high BP, or on BP-lowering drugs. They will have to be satisfied with snorkeling, diving not more than 2 or 3 meters (6–10 feet).
Squash and other similar extremely active and exhausting competitive sports are unwise, and so are all kinds of static exercise such as weight-lifting, press-ups and body-building.
Apart from these, there is virtually no sport that people with treated and controlled high BP cannot do, providing they get themselves sensibly into training, and do not rush into very demanding activities for the first time in middle-age. People who maintain regular exercise tend to have lower BPs. Swimming is probably the best form of exercise, as it remains possible even for older people with joint and back pain. Cycling is a good alternative for people without back pain.
Sex
I am worried that I won’t be able to make love to my partner as often as usual. Does high BP affect sexual appetite or performance?
Roughly 5% of middle-aged men, and an unknown proportion of women, have problems of diminished desire and/or performance. There is no evidence whatever that high BP itself affects either of these, but, in any large group of men with high BP, this figure for failure of erection is likely to be nearer 10% or more. This is not because of high BP itself, but because of other factors, such as:
• Health changes commonly associated with erection failure, for example diabetes;
• Causes of high BP, such as obstruction, for example, of the aorta or of arteries in the pelvis; • blood-pressure lowering medication, most commonly high dosage of diuretics;
• Worry and loss of confidence associated with the diagnosis of high BP.
Sex starts in the mind. If the mind is disturbed or preoccupied with other worries, such as ‘Will I (or my partner) have a brain haemorrhage from high BP while we make love?’, the sequence of first emotional changes then physical changes, which must occur before successful lovemaking can take place, may not even begin; or, having begun, may at any point be interrupted.
Depending on where this interruption occurs, the consequences may be:
• Loss of desire or failure to obtain an erection;
• Having obtained it, failure to maintain it until both partners achieve orgasm; or
• Premature ejaculation.
Although all these failures refer to men, in whom they are more obvious, there is no reason to doubt that they happen also in women, for whom erection of the clitoris is just as necessary as penile erection in men.
Men who usually have good erections when they wake in the morning can be sure that there is unlikely to be a physical problem. Whatever problems they have are probably connected in some way with their own mind, or the interaction between minds necessary for a successful relationship. Problems of this sort can often be solved simply by discussing them frankly with your partner, a simple step many find very difficult to take. If problems can’t be sorted out in this way, you should look for help from an experienced and sympathetic counsellor. Local Family Planning clinics and marriage counselling units can usually organize this for you.
Men who rarely or never have good morning erections nearly always have an underlying physical cause, because of problems either with their blood supply or nervous control of the penis. Both these impairments are very common in people with diabetes, often at an early stage in the disease. As diabetes is much commoner in people with high BP than it is in the general population, failure of erection is also commoner among people with high BP.
Erectile failure from a physical cause (‘organic impotence’) can be treated in several ways. Drug treatment with sildenafil (Viagra) or one of the newer ones (tadalafil [Cialis], vardenafil [Levitra]) enables many men to achieve a satisfactory erection. Viagra should be taken about an hour prior to sexual activity. Adjustment of the dosage may be necessary and you should not take it if you are already taking certain antianginal medication (nitrates). If in doubt, consult your GP.
In men in whom Viagra doesn’t work, there are alprostadil injections. This drug is injected into the skin at the base of the penis with a very fine needle. This will last for 10–20 minutes, and can be repeated. This sounds awful, but usually works very well, particularly if the main problem is impaired nervous control rather than impaired blood supply, as it usually is in diabetics. Another choice is the vacuum therapy device (VTD), consisting of a vacuum chamber with a constriction ring, and a hand- or battery-operated pump. It creates a negative pressure around your penis, increasing the blood flow, thus inducing an erection. The constriction ring maintains it.
Finally, you can consider having a surgical operation to implant either a fixed or variable internal splint into the penis, so that you can make an erection. This also generally works very well. The latter two options require referral to a specialist clinic.
Erectile failure caused by BP-lowering medication is relatively common, mainly from diuretics (often in excessive doses), beta-blockers and methyldopa, but occasionally with all such drugs. Impotence from this cause is always reversible; it stops soon after stopping the drug. If it doesn’t, the drug is not the cause.
Will having sex raise my BP?
Yes, but transiently. As in any other vigorous physical activity, BP rises moderately in anticipation, and steeply during performance. It falls quickly afterwards, and there is some evidence that regular sexual activity may reduce rather than increase average BP at other times.
I already have a high BP. Can sexual activity be dangerous for people with high BP?
Activities that cause very high peaks in BP, such as weight-lifting, push-ups, or pushing a car out of a ditch, are dangerous for people known to have uncontrolled high BP, and unwise even if high BP has been controlled by medication. The risks are of acute coronary insufficiency leading to interruption of normal heart rhythm, and bleeding from a brain artery leading to stroke. Even if sexual activity were to raise BP to the same extent and for similar lengths of time, this might not carry the same risk. The whole body is in a transiently exalted state during sexual activity, in which perception of pain, for example, virtually disappears; many other changes occur other than raised BP, probably including changes in blood coagulability, which are more likely to prevent than to cause a heart attack or stroke. Coronary thrombosis and heart attack can occur occasionally during intercourse, and stroke is not impossible. However, even these rare events seem to happen far less often during sexual activity than in common and equally physically demanding sports.
I have high BP for which I am taking tablets. I am having problems with getting an erection. What advice can you give me?
There are several aspects to this question. Firstly, taking any medication for high BP does not stop a man using treatments for erectile failure.
The second issue is that some people think that their drug given for high BP has caused the failure. You might have noticed this only when the BP-lowering treatment was started. The real problem, however, lies in the underlying disease, which has narrowed your blood vessels and hence caused your BP to rise, and stop the blood flowing to the penis. It is very important, if your doctor has put you onto a BP-lowering drug, not to stop it if erection failure follows, but to return to your doctor and discuss this issue with him. Your doctor should easily be able to prescribe another drug to control your BP and this could help your problem. It is, however, true that some of the older drugs treating high BP do cause more problems than some of the newer drugs. So your doctor may decide to change your treatment for high BP to see if one drug can control both your BP and erection problems.
