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A New Front in the War on Doping

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Edge-seeking athletes are increasingly turning to drugs typically prescribed to aging cardiovascular patients

By KEVIN HELLIKER and SARA GERMANO

March 17, 2016 6:50 p.m. ET

Aging runners diagnosed with high blood pressure often resist taking medication, out of pride or fear of side effects.

But sports cardiologist Paul Thompson has a strategy for overcoming that resistance. “I tell them there’s a drug I can give them that may have some exercise benefits, that some people believe improves performance,” says Thompson, chief of cardiology at Hartford Hospital in Connecticut.

Thompson is quick to add that there’s no hard evidence for the performance-enhancing benefits of ACE inhibitors or ARBs, two classes of high-blood-pressure medication. But for many hypertensive runners under his care, lack of proof doesn’t matter: The mere possibility of a competitive edge is enough to persuade them to follow medical recommendations and take a pill.

The intersection of athletic performance and cardiovascular drugs fell under scrutiny in recent days when tennis star Maria Sharapova admitted she had tested positive for meldonium, a drug often used to increase blood flow in cases of heart failure. The World Anti-Doping Agency began treating meldonium as a banned substance only this year, and already about 100 athletes have tested positive.

In the war on doping, long associated with fountain-of-youth substances such as testosterone and human growth hormone, the case of meldonium suggests that edge-seeking athletes may be turning to drugs typically prescribed to aging cardiovascular patients. Possible further evidence of that is telmisartan, a widely prescribed high-blood-pressure medication. In recent years, doping blogs have promoted telmisartan as a possible performance enhancer. In 2015, WADA added telmisartan to the list of drugs it is monitoring, a possible first step toward banishment. Before it became banned this year, meldonium was on the agency’s watch list.

Substantial doubt exists that these drugs enhance performance. “I do not believe that meldonium has been shown to enhance performance,” Don Catlin, the Los Angeles-based anti-doping scientist. Asserting that WADA now boasts the resources to test for performance-enhancing qualities—but apparently conducted no such analysis of meldonium—Catlin said, “Technically it should not have been banned.” A WADA spokesman declined to return calls seeking comment.

But Catlin, a pioneer of drug testing, acknowledges that athletes often know before scientists do that a particular substance or procedure enhances performance. And the large number of recent positive tests for meldonium raises the question why so many athletes would be taking a drug designed to improve blood flow in cardiac patients. That number is all the more surprising considering that the drug isn’t approved for use in America or hardly anywhere outside Eastern Europe or Russia.

In the case of Sharapova, she said her family doctor recommended Mildronate, the brand name of meldronium, because of recurring illnesses, low magnesium, irregular electrocardiogram results and a family history of diabetes. The Russian tennis star, who lives in the U.S., said this month she missed alerts from WADA that the drug had been placed on the banned list, and failed a drug test at the Australian Open. Her punishment remains to be determined.

On the surface, it makes sense that athletes might benefit from drugs that improve blood flow and cardiac function in heart-disease patients. Often, studies showing the efficacy of these drugs include evidence of enhanced exercise endurance in patients who take them. But Catlin notes that that improvement typically restores endurance to normal levels—not the extraordinary edge sought by athletes.

The extent of telmisartan usage among athletes is unclear. But the drug is receiving positive reviews on sites such as roidvisor.com. In an article last October lamenting WADA’s tendency “to take the fun out of doping,” that site noted that telmisartan isn’t banned, and “promises to enhance running ability, increase fat burning ability, reduce lactic acid formation and enhance recovery from exercise.”

Ben Nichols, a spokesman for WADA, said telmisartan was on the radar of the anti-doping agency as far back as 2012 “but there was insufficient evidence to add it to the monitoring program” at that time. Since then, he said, more research has become available and the drug, also known by the brand name Micardis, was added to the monitoring list.

As yet, telmisartan’s performance-enhancement ability is theoretical. In a 2012 article in the Journal of Strength and Conditioning Research, Spanish sports physician Fabian Sanchis-Gomar pointed to research suggesting that telmisartan “might induce similar biochemical, biological and metabolic changes” as certain banned agents.

Telmisartan is a so-called angiotensin II receptor blocker, or ARB. Like another class of hypertension drugs called ACE inhibitors, ARBs reduce levels of an agent that constricts blood vessels. Studies have shown that people with genetically lower levels of that agent are over-represented among elite athletes, leading to theories that ACE inhibitors and ARBs could improve aerobic capacity, muscle function and response to training. “These drugs could potentially make it easier for the heart to pump blood and for blood to enter the muscles,” says Thompson, the sports cardiologist. “But there is no proof of that.”

Write to Kevin Helliker at kevin.helliker@wsj.com and Sara Germano at

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