[Hypertension, the heart and physical activity (sports)]

Cross-sectional analyses show a lower incidence of hypertension among endurance athletes compared to the general population, but not among strength athletes or high-performance swimmers. The favorable influence of increased physical activity of the endurance type on cardiovascular regulation is based on peripheral adaptation processes with a reduction in sympathetic tone and elevation of parasympathetic tone. The results are a reduction in catecholamine release, in heart rate, and in mean arterial pressure at the same exercise level. Following chronic strength training there is also a slight reduction in catecholamine levels at the same time the vagal activity decreases, so that no reduction in heart rate and pressure, and thus no economization of cardiac work results. Thus, endurance training is suited for prevention and also for the reduction of blood pressure in primary hypertension and for cardiac relief, while strength training is not. In the case of hypertension, physical activity may only be engaged in when the cardiac functional status and other organ impairments are known. The stages of cardiac adaptation and damage, particularly the differentiation between concentric and eccentric hypertrophy, are particularly important. Exercise ECG and echocardiography are therefore obligatory measures prior to initiating physical activity and for continuous monitoring of hypertension. In primary hypertension Stage I (70-80% according to WHO), in which no cardiac hypertrophy is present, endurance training may be started without drug therapy if diastolic pressure is not greater than 104 mmHg and systolic pressure up to 170 mmHg (mild hypertension). Additional drug therapy does not show any convincing advantages. Higher pressures require adjuvant drug therapy. In concentric cardiac hypertrophy (Stage II), there is clear indication for the use of hypotensive drugs. An endurance sport is to be recommended additionally after normalization of blood pressure; the regression of cardiac hypertrophy should be examined within one year. In eccentric hypertrophy (damage stage), "training" is not indicated in addition to drug therapy, but rather physical therapy according to defined exercise capacity. The selection of medications for reducing blood pressure in sportsmen must take into consideration that they have varying performance limiting effects, which may be an essential factor in compliance.