Exercise Hypertension in Athletes

Area of Science:

• Cardiology
• Sports Medicine
• Exercise Physiology

Background:

• An exaggerated blood pressure response (EBPR) during exercise testing lacks a standardized definition, leading to varied diagnostic thresholds across different guidelines.
• Preparticipation screening for competitive athletes necessitates clear criteria for identifying EBPR and its clinical implications.

Purpose of the Study:

• To compare the prevalence of EBPR in competitive athletes using different established guidelines.
• To investigate the association between EBPR and left ventricular hypertrophy (LVH) in athletes without known hypertension.

Main Methods:

• Competitive athletes undergoing preparticipation screening were assessed for EBPR using American Heart Association (AHA), European Society of Cardiology (ESC), and American College of Sports Medicine (ACSM) guidelines, alongside the systolic blood pressure/MET slope method.
• Prevalence rates of EBPR and left ventricular hypertrophy (LVH) were determined, and associations were analyzed, controlling for age and sex.

Main Results:

• The prevalence of EBPR varied significantly by guideline: ESC (19.6%), AHA (15.0%), and ACSM (6.8%).
• Left ventricular hypertrophy (LVH) was detected in 20.5% of athletes and was more frequent in those with EBPR.
• EBPR defined by AHA and ACSM guidelines, as well as the systolic blood pressure/MET slope method, showed an independent association with LVH in adult athletes.

Conclusions:

• Divergent guidelines for EBPR screening exist, impacting prevalence estimates in competitive athletes.
• The American Heart Association (AHA) guideline and the systolic blood pressure/MET slope method demonstrated independent predictive value for left ventricular hypertrophy (LVH) in adult athletes, unlike the ESC or ACSM criteria.