Safety of hypertension pharmacotherapy in recreational scuba diving patients

Abstract

Scuba diving is usually called a high-risk sport. This term does not fully reflect the essence of this activity. Depending on goals, scuba diving may be associated with an increased risk, but recreational scuba diving is a safe and restful sport. Hypertension is a common disease in the general population, therefore it occurs quite often among divers. Modern pharmacotherapy of arterial hypertension is based on several assumptions presented in the guidelines of the European Society of Hypertension and the European Society of Cardiology. The most important of them is the introduction of drug combinations from the very beginning of therapy because, in view of the complex etiology of arterial hypertension, one cannot expect the high effectiveness of monotherapy. Pharmacotherapy of hypertension in a scuba diver must take into account the physiological aspects resulting from this sport. The most important of them include reflex bradycardia, appearing after immersion of the face, secondary to the stimulation of the reflex arc, the V nerve - the X nerve. In addition, during contact with cold water, peripheral vasospasm, increased pulmonary pressure or the risk of immersion pulmonary edema may occur. Scuba diving involves breathing air, or another gas mixture that, for technological reasons, must have practically zero humidity. Breathing such a mixture can result in dehydration. The increase in blood pressure in the atria of the heart as a result of the activation of appropriate baroreceptors increases the production and release of natriuretic peptides - in particular the A-type natriuretic peptide. As a result of its action, diuresis is increased, and the vascular endothelium produces endothelial factors with a diastolic effect, such as nitric oxide. Monitoring blood pressure alone should reduce the risk of fluctuations in blood pressure during activity. Therefore, arterial pressure should be lowered to the threshold values with the possibility of appropriate changes adapting to physical exertion. Arterial hypertension, if effectively treated, is not a contraindication to sports activities, including scuba diving. Planning the therapy, a doctor should always pay attention to the selection of drugs to minimize the risk of side effects, especially those potentially related to the physiology of scuba diving, hence it is obligatory to expand the patient's anamnesis with sports practiced by the patient. The first-line drugs safe for scuba divers are ACEi, sartans, and calcium channel antagonists, while groups to be avoided are diuretics and beta-adrenolytics.