Bodybuilding Heart Health

Blood pressure elevations in bodybuilders- know the dangers

By Kim Crawford, M.D. Last updated: February 13, 2021
kidneys can be why you get high blood pressure

High blood pressure is a common in “everyone” but more so in bodybuilders:

l carnitine bodybuilding can help preventHigh blood pressure is a major public health problem. The AHA estimates that hypertension affects approximately one in three adults in the United States.

This translates to about 76.4 million people. Blood pressure is determined  by the amount of resistance to blood flow in your arteries as well as the amount of blood your heart pumps out. The more blood your heart pumps per beat coupled with the narrower your arteries are, the higher your B.P. will be.

You can have hypertension for years and not feel any symptoms. However, damage to blood vessels and your heart continues until the pressure is reduced.

Hypertension increases your risk of serious health problems, including heart attack and stroke. Fortunately, hypertension can be easily detected. Once you know you have high blood pressure, you can generally get it under control. But here is some “on the side” info that applies both to non-bodybuilders and bodybuilders.

Nitric oxide is a crucial signaling molecule throughout the body. It is made by endothelial cells-smooth muscle cells which line the arteries.

It’s a potent vasodilator- meaning it relaxes arteries. Therefore, nitric oxide plays an important role in blood pressure and overall circulation and more.

It also keeps the endothelial lining of blood vessels in good shape by helping to reduce inflammation and oxidative stress. It also decreases clotting by dimishing the ability of red cells and platelets to clump and form clots.

Your body generates it’s own nitric oxide in the endothelial walls. However when someone has vascular disease meaning any type of hardening of the arteries or elevation of B.P., there is what is called “endothelial dysfunction.” This means the blood vessels have a much reduced capacity to produce nitric oxide. And supplements are a must. I’m talking about nitric oxide enhancers and almost no doctor knows about this or recommends this other than some A4M docs like me. But if you DON”T do this you’ll notice that your B.P. will keep going up and up and you’ll need more of this, then that-and so on. Sound familiar? Then get some l-arginine/l-citrulline nitric oxide supplementation like we have in the bodybuilding store-it works and also for you bodybuilders-it amps up your workout! Now back to blood pressure.


Why you want to have normal blood pressure:

Arterial Blood Vessels: High B.P. thickens the walls of blood vessels. This increase the resistance against which the heart needs to pump. Therefore it can increase the risk of strokes and kidney failure.

Heart:  H.B.P. Due to the resistance increase described above, the heart then first thicken’s it’s walls  because more force is needed to pump blood. Thicker walls = stiffer walls. This means that the heart becomes less efficient at pumping blood. Eventually this leads to dilation (“bagginess” ) of the heart and congestive heart failure.

Kidney Damage: Over time, hypertension can narrow and thicken the blood vessels of the kidneys. The kidneys are then not able to filter urea from the blood as they should. This waste builds up in the blood. The kidneys may fail altogether in which case dialysis and then a transplant is needed.

Eyes: Uncontrolled hypertension can cause blood vessels in the eye to bleed or even burst. There are some famous powerlifters who have burst blood vessels in their eyes doing a max rep.

Brain: Hypertension is one of the key risk factors for stroke. Very high pressure can cause a break in a weakened blood vessel, causing a “brain bleed.”

This can cause a hemorrhagic stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a stroke.

(Back to the nitric oxide enhancement here-less clots so when BP is controlled,very unlikely to happen on an NO enhancer.)

Most people with high blood pressure have no symptoms, even if their blood pressure is dangerously high.  A rare few people with high blood pressure may have nosebleeds or headaches, but these symptoms  generally don’t occur until high blood pressure is life-threatening.

Weightlifting ACTUALLY Improves Hypertension

A study done several years ago tested 15 middle-aged men with hypertension.

They all had an average BP of 150/90 and they normally exercised less than two hours per week.

They were put on a three-times-weekly weightlifting program and they all stopped taking their BP medications six weeks before the study.

The training program included a “comfortable” (last rep was easy) three sets of 12 reps of seven machine-based resistance exercises, with one-minute rest periods between exercises.

After 12 weeks, in addition to increased lean body mass and lower body fat, the average blood pressure of the entire group was much lower! The average BP was 134/80.

Raised Blood Pressure and Bodybuilding-Why?

With a safe exercise program, a healthy person generally doesn’t have an issue with B.P.  However, bodybuilding puts an  enormous amount of physical stress on the cardiovascular system, causing a temporary raise in blood pressure. In addition some bodybuilders use the Valsalva maneuver as way to brace themselves and increase the amount of weight they can lift. This involves forcefully exhaling against a closed mouth and nose. It increases pressure on the middle ears and chest, and can cause highly raised B.P. But this,too is temporary-so why so much hypertension in the bodybuilding community?

The classically thought reason for High BP in BB’s:

Most medical writings which discuss the side effects of anabolic steroids suggest that the cause is their sodium-retention properties.

We know definitively that anabolic steroids inhibit the enzyme 11-beta hydroxylase.

This then leads to excessive production of deoxy corticosterone, a mineralocorticoid in the adrenal glands.

This mineralocorticoid excess then leads to salt and water retention-thus the complaints of “bloating” by AAS takers.

This then can easily lead to elevation of blood pressure. In response many bodybuilders add diuretics to their regimens  but that leads to other potential problems, such as a electrolyte imbalances and dehydration.

The diuretics may drop the BP a bit but the endothelial damage progresses past the point where diuretics could “keep things under control.”

The answers finally started coming at ENDO 2016:

At the annual meeting of the Endocrine Society in Boston, a well done study was presented showing the definitive link between anabolics and serious increases in blood pressure.

The researchers used 100 male bodybuilders up to 50 years of age.  They divided them into three groups: 37 who were taking anabolics (uncontrolled for oral vs IM), 33 had formerly taken anabolics, and 30 athletes were the “control group” who had never used anabolic steroids.

Rasmussen and colleagues measured each person’s blood pressure using 24-hour ambulatory blood pressure measurements (ABPM) because previous studies using convention methods yielded conflicting results. ABPM is considered to be a superior method for diagnosing hypertension rather than conventional sphygmomanometer (blood pressure cuff while seated) measurement.

They measured the men’s 24-hour ABPM every 20 minutes during the day and then at hourly intervals during the night. The ongoing AAS taker’s  average day and night systolic blood pressure values were significantly higher, by roughly 8-10 mmHg, when compared with the former AAS users and the control group. The researchers classified daytime hypertension as 135/85 mmHg or higher and nighttime hypertension as 120/75 mmHg or higher. No  bodybuilding male hormones or  supplements which also can affect muscle mass were used by any subjects.

Note from me: In this study, diastolic pressure didn’t differ statistically, leading to the “increased resistance” theory discussed below where constriction of peripheral arteries was the key factor. This was likely especially relevant in the AAS using group as those who use AAS are known to have high catecholamine (adrenaline,etc) levels. The former users were likely to already have damage to their vascular endothelium causing their B.P. elevations. It would have been interesting to see if any of the current or previous users took NO supplementation but this was not controlled for.

Yet another study:

During the last year, a new study has emerged looking at what I just discussed above which actually makes physiologic sense. Although the study is small it is well done, other than combining orals and IM’s.

12 anabolic users and nine drug-free men around the age of 30 were compared. All of the subjects had been bodybulding for at least two years. Those in the AAS group took their self-administered regimen  for at least one month prior to the study.

They had also used anabolics for at least two years. They did 2-4 cycles per year. The researchers wanted to know whether using AAS increased the release of sympathetic hormones (catecholamines), such as epinephrine and norepinephrine.

These neurochemicals both cause a contraction of the smooth muscle (endothelium) in arteries, and chronically elevated amounts of them can cause blood pressure to be elevated due to the constricted arteries.

The AAS users were measured to have increased muscle sympathetic nerve activity and reduced forearm blood flow compared to those not using the drugs. They also had higher 24-hour blood pressure readings.


Previous studies have demonstrated that anabolic steroids may boost blood pressure by interfering with the activity of nitric oxide benefits , which was discussed earlier. It is well known that AAS increase mineralocorticoid activity, causing fluid retention.

It has now been reasonably well demonstrated that AAS use leads to high circulating sympathetic amine levels causing vasoconstriction and further damage. This goes hand in hand with a myriad of clinical observations of lab testing of these athletes showing high cortisol levels, thought to be due in part to the high levels of catecholamines.

For those taking AAS I would advise reading about the surprising alternatives in this blog. If you decide to continue AAS just know your risks and monitor your BP. Unlike liver and cholesterol issues, unfortunately no matter WHAT anyone tells you, there is no “kidney cleanse” for AAS kidney disease which is yet another cause of high B.P. in bodybuilders.

And it has not been studied, but I personally would wager that NO (nitric oxide) levels drop BEFORE we see a rise in B.P. and think that if NO supplements are taken and cortisol is controlled with adrenal support that perhaps there is a chance to diminish the amount of blood pressure increase. Not studied. Just postulating here. You need to control your cortisol anyway and you KNOW you are depleting NO so why would you not take care of these two things?

Footnote on treatment: Most doctors use a diuretic as a first-line treatment which in this case is appropriate due to most BB’s having bloating. However if you are put on HCTZ you need potassium and magnesium supplements. And you SHOULD take a nitric oxide enhancer, not to be a nag-but this slows progression. Or drink 8 ounces of beet juice daily.

I am also suggesting here that since we know (if you take AAS), that means you have increased mineralocorticoid (aldosterone-like-salt-retaining) activity AND increased sympathetic activity. So I would personally recommend that we always think of the physiology when treating anything which is why I would choose only a small dose of diuretic but also add an ACE inhibitor because doing so will bring down aldosterone and bring down catecholamine levels. And nattokinase supplements are always a good addition. Here are all of the natural ways to lower blood pressure.


References: Found in the article linked in the last sentence


  1. Great article,am bringing to show my doctor.

  2. I could not resist commenting. Well written!

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