Enalapril proves better for those who exercise

The old image of the hypertensive patient — sedentary, obese, and unfit — is giving way to a healthier reality: Many of those with high blood pressure engage in frequent, vigorous exercise. And that’s making the choice of an antihypertensive drug more important than ever. A new study suggests that enalapril — and perhaps other ACE inhibitors, as well — are better choices for exercising hypertensives than beta-blockers.

The reason is simple: People tend to feel "low" a few hours after taking a beta-blocker, and therefore may not exercise. While both ACE inhibitors and beta-blockers provided comparable hypertensive relief, enalapril-takers experienced significant advantages in terms of maximal oxygen uptake and exercise tolerance, the study found. Plus, atenolol significantly increased triglyceride levels and the LDL/HDL ratio. Enalapril didn’t.

In light of this study, pharmacists counseling cardiac patients may want to ask specific questions about when patients exercise in relation to when they usually take once-daily antihypertensive medications. Many patients taking a beta-blocker in the morning are probably better off exercising later in the day vs. shortly after using the drug, the study suggests.


Gordon NF, et al. The effects of atenolol vs. enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men. Am J Cardiol 1997; 79:1,065-1,069.