Introduction by Linda Lee, Nurse Practitioner

Welcome to the running of the 2007 Western States Endurance run!

My name is Linda Lee and I am thrilled to be the medical advisor to this prestigious event. I am a Nurse Practitioner with a background in emergency and wilderness medicine.

I would like to introduce this informal, interactive resource to the existing WS100 web site. In the upcoming months you will be increasing your miles as well as fine-tuning your training strategy. With this, come the occasional ache, pain and minor injury that can interfere with your plan. You will want to know about heat, snow, altitude, electrolytes and possible environmental emergencies that can occur on the WS trail. As the anticipation of the run grows with each day, I hope to relieve some of the stress by providing available medical information.

High Blood Pressure affects over 60 million people in the United States. The diagnosis is defined as a blood pressure of 140/90. Overall, HTN (hypertension) is more prevalent in older age groups (over 40). HTN remains a major public health burden. Despite the rigorous exercise schedule of ultra runners, you are not immune. I encourage each runner to have a screening medical exam prior to taking on such a physically demanding endurance event.

There are different classes of blood pressure medications, one being the Beta Blockers. These are the drugs that end in “lol”. Common drugs in this class are metoprolol, atenolol, labetalol, and propranolol. If you are one of those on an anti-hypertensive medication, check to see if it is beta-blocker or one of the combination drugs.

Beta-blockers are competitive inhibitors of catecholamines at the beta-adrenoreceptors sites. B1 receptors are found primarily in the heart. B2 are found in the heart but are most prominent in the bronchial and peripheral vascular smooth muscle. So when the beta-receptors are blocked, there is a slowing of the heart rate, and contractility. Rather than dilation of the bronchial, and peripheral vascular smooth muscle, there can be a side effect of bronco-constriction. The blood flow to muscles can be reduced.

What this means to an ultra runner is that when you have to climb out of El Dorado Canyon, you are not able to increase your heart rate to meet the demand of the exercise. Your legs may feel sluggish and some people wheeze. You loose the capacity to exercise to your full ability!

Although beta-blockers can be excellent anti-hypertensive medication, and are very useful in certain kinds of heart failure and heart attacks, they can cause a lot of problems for the athlete.

Another anti-hypertensive drug that is counter-productive in an extreme athlete is a diuretic.

Hydrochlorothiazide is one of the first line drugs for HTN. It does not make sense to use this drug because it can add into the effects of dehydration and electrolyte disturbances during the endurance running events.

Good communication with your health care provider can facilitate fine-tuning your blood pressure. Never just stop your medication, but rather explore the alternative anti-hypertensive that does not have an effect on exercise tolerance.

-- Linda Lee, F.N.P.