Hypertension in athletes

Abstract

Regular physical activity and training are associated with reductions in blood pressure (BP), yet elevated BP is one of the most common abnormalities found during the pre-participation physical evaluation of athletes. Hypertension (HTN) remains the most common cardiovascular condition encountered in athletic populations, therefore all athletes require screening for HTN. Because athletes often have white coat HTN, BP recordings outside the office are also necessary. The 36th Bethesda Conference classified sports according to their varying physiologic demands and provided specific recommendations for the evaluation, treatment, and sport participation of athletes with HTN. In general, angiotensin-converting enzyme inhibitors and other vasodilators are the medications of choice for active and athletic patients because of their limited interference with cardiovascular conditioning. Other agents can be used but some sports governing bodies proscribe the use of certain antihypertensive medications such as beta-blockers for elite athletes.

Figure

Classification of sports. This classification is based on peak static and dynamic components achieved during competition. It should be noted, however, that higher values may be reached during training. The increasing dynamic component is defined in terms of the estimated percent of maximal oxygen uptake (Max O₂) achieved and results in an increasing cardiac output. The increasing static component is related to the estimated percent of maximal voluntary contraction (MVC) reached and results in an increasing blood pressure load. The lowest total cardiovascular demands (cardiac output and blood pressure) are shown in green and the highest in red. Blue, yellow, and orange depict low moderate, moderate, and high moderate total cardiovascular demands, respectively. *Danger of bodily collision. †Increased risk if syncope occurs. Reprinted with permission from Mitchell et al.