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Old 12-15-2008, 03:39 PM   #1
Jeff Chalfant
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My new client was just but on blood pressure meds

He is 30 years old, probably 13-16% body fat. 5'7"-5'8'' 150lbs. He has a family history of high cholesterol and associated death.

Here is what gets me. He has JUST begun his first exercise program ever.
He started CrossFitting about 2 months ago and he hasn't even changed his diet yet.

What is his doctor thinking by not waiting to see what exercise + nutrition will accomplish?!

The way I train most people is to recommend 1 change at a time so now would be the time to start working on nutrition with him, but a low sodium diet is contraindicated with his bp medication!!!

I will still be working on nutrition with him, but now his workouts are suffering big time. He is dizzy, weak, and lightheaded. It is my responsibility as a trainer to tell him to back off if he feels this way since his medication works by drastically affecting his sodium, chloride and potassium levels, and significantly messing with his blood pressure. What the heck do I tell this guy?

I will be talking to his doctor. Success stories and / or links to information on this would be very helpful.
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Old 12-15-2008, 03:56 PM   #2
Robert Pierce
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Re: My new client was just but on blood pressure meds

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What is his doctor thinking by not waiting to see what exercise + nutrition will accomplish?!
In all likelihood, the best interest of his patient. The risk of CVD begins to increase at 115/75 and doubles for every 20/10.

What is his blood pressure? (Two or more readings)
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Old 12-15-2008, 04:06 PM   #3
Jeff Chalfant
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Re: My new client was just but on blood pressure meds

I don't know his bp but every anti hypertension medication manufacturer I have seen explicitly says to consider their medication only after nutrition and exercise fail to lower bp. I will ask him but I'm pretty sure he won't know what his pressure is.

I'm sure his doc has his best interest in mind, I'm just ****ed that he seems sicker now. His doc has added a nasty chemical to a system which is already in poor health due to 30 years of poor nutrition and zero exercise.
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Old 12-15-2008, 04:27 PM   #4
Karin Jonczak
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Re: My new client was just but on blood pressure meds

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Originally Posted by Jeff Chalfant View Post

...a low sodium diet is contraindicated with his bp medication!!!
that's weird. what med is he on...?

would be interesting to know what his BP was before the meds, get him to call his doctor and find out (should have been at least TWO consecutive visits with high numbers or evidence of organ damage with one high reading though organ damage seems unlikely given how young he is)

seems a bit premature to put him on meds if he has no risk factors. Protocol says try diet and exercise first (but also not to wait if he does have risk factors)... dose he know what his lipid levels are?
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Last edited by Karin Jonczak : 12-15-2008 at 04:32 PM.
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Old 12-15-2008, 06:10 PM   #5
Robert Pierce
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Re: My new client was just but on blood pressure meds

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...consider their medication only after nutrition and exercise fail to lower bp...
Not sure where you read this, but depending on the patient's blood pressure, it is bad advice...for a physician, in certain circumstances, it is malpractice.

It depends on the patient's blood pressure. For those with prehypertension, lifestyle changes are entirely appropriate. But if the starting blood pressure is higher, initial treatment with diet, lifestyle changes, AND medication may be most appropriate. If the blood pressure is high enough, intiating therapy with TWO agents is indicated.

Now, it sounds as if he is having side effects from his med. He may need a different med. Is he taking a diuretic? According to the older (2003) guidelines, this is appropriate initial therapy, but newer data suggests that although diuretics improve a variety of outcomes, they may increase blood sugar, and in conjunction with a beta blocker, increase the risk of diabetes. Many of us have moved to ACE inhibitors or ARBs for initial therapy.

You patient and his doc have a lot of choices for treatment of his HTN.
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Old 12-15-2008, 08:49 PM   #6
Jeff Chalfant
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Re: My new client was just but on blood pressure meds

yeah it is a diuretic. chlor-something. I read all about it before I got worked up, and that statement about trying and nutrition exercise first, as well as avoiding low sodium diets was in the official literature from a manufacturer.
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Old 12-19-2008, 09:48 AM   #7
Jason Hicks
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Re: My new client was just but on blood pressure meds

Probably hydrochlorothiazide. It works by inhibiting sodium resorption in the kidney. That is why they dont recommend a low sodium diet. That would be burning the candle from both ends and could lead to a electrolyte imbalance fast.
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Old 12-23-2008, 11:10 PM   #8
Brian De Mio
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Re: My new client was just but on blood pressure meds

Your viewpoint is very interesting. I would wish that every patient I recommended to diet and exercise would immediately hop on that bandwagon and do it. I've been doing this for some time and counsel heavily on the benefits and necessity of the two. I would say that is probably the least utilized prescription I give.

I would venture to say that the Physician is likely following the JNC guidelines and due to family history of deaths (especially if they are under age 50) has a very good reason for this treatment.

There are a couple issues you should explore. First are the deaths due to cardiovascular disease or cardiac syndromes? Those syndromes are more concerning because there are a lot of athletes out there that drop dead while they are exercising even after they have been seen by a physician.

Second has the physician given him a clean bill of health to exercise? I'm not a trainer in any way shape or form but as a medical officer I'm very well aware of the liability involved if I say its okay for a patient to exercise and he dies suddenly while working out. Because of this client's medical and family history I would insist on seeing an approved physical clearing him for exercise. I would also insist he discuss his symptoms with his Physician. It may just be a case of an out of shape client and he will improve but (god forbid) what if it isn't and he has an actual problem being aggravated by the exercise?

Don't want to sound like the know it all here or anything I'm just thinking "safety first" is a good motto to go by in this case.
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Old 12-24-2008, 04:03 AM   #9
Robert Pierce
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Re: My new client was just but on blood pressure meds

Brian makes a good point. I will add that it is unlikely that the client will have a history of a "cardiac syndrome." If there really is such a family history, it will typically be reported as a "heart attack" or if lucky, "sudden (cardiac) death." The family history sounds more like familial hyperlipidemia, but we're just guessing here.

The med sounds like chlorthalidone. I am not familiar with this "avoid a low sodium diet" thing: http://www.nlm.nih.gov/medlineplus/d...s/a682342.html (wfs)
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Old 12-25-2008, 06:33 PM   #10
Jeff Chalfant
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Re: My new client was just but on blood pressure meds

It is Clorthalidone. What sucks is that he was seeing massive improvements in performance and now he is completely worthless during all his workouts. Zero stamina or cardiovascular endurance and he frequently has to lay down due to dizziness. His family history is of hyperlipidemia, not cardiac syndromes btw. It would have been nice to see what exercise alone, and then positive dietary changes could have accomplished for him.

I read the low sodium diet thing on another detailed description of the drug.

He signed my par-q and indicated his doctor has encouraged him to exercise. His systolic was 140.
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