Medicine and cardiac rehab

Some prescribed medicines can change your heart rate, blood pressure, and overall ability to exercise. Therefore, it is important to identify and understand how each drug can affect these measurements in order to safely exercise during cardiac rehab.

Medicine effects

Drugs

Affect heart rate (HR)?

Affect blood pressure (BP)?

Affect overall exercise capacity?

Angiotensin-converting enzyme (ACE) inhibitorsNoLower BPNo
Antiarrhythmic agentsNoNoNo
Beta-blockersLower HRLower BPDecrease, but may increase if you have angina
BronchodilatorsRaise HRNoIncrease capacity
Calcium channel blockersRaise or lower HR (depending on the drug)Lower BPNo
DigoxinLower HRNoIncrease, if atrial fibrillation or heart failure is present
DiureticsNoLower BPNo
Hyperlipidemic agentsNoNoNo
Nitrates (nitroglycerine)Raise HRLower BPIncrease, if angina or heart failure is present
VasodilatorsRaise HRLower BP (raises BP after exercise)No

What about other medicines and exercise?

Many people recovering from heart conditions are clinically anxious or depressed. These symptoms usually go away within 6 to 9 months. However, it is important to be aware of this risk and to be screened for signs of anxiety or depression. Medicines for anxiety or depression may affect your blood pressure and heart rate. Be sure your doctor knows what medicines you are taking.

  • Antidepressants may increase your heart rate as well as decrease your blood pressure at rest and during exercise. But some antidepressants can increase blood pressure.
    • Selective serotonin reuptake inhibitors (SSRIs) have few heart-related side effects.
    • Dual-acting serotonin and noradrenaline reuptake inhibitors may increase your heart rate and blood pressure.
  • Minor tranquilizers may lower both your heart rate and blood pressure by controlling your anxiety. They will probably not affect your exercise capacity.
  • Major tranquilizers may lower both your heart rate and blood pressure at rest and during exercise.
  • Lithium will likely not change your heart rate or blood pressure at rest or during exercise. This drug may affect your ECG by causing T-wave changes and arrhythmias both at rest and during exercise.


Author: Robin Parks, MSLast Updated: October 16, 2006
Medical Review: Caroline S. Rhoads, MD - Internal Medicine
Cheryl Allind, RN, BS - Cardiac Rehabilitation
Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology

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