Male Endurance Athletes Often Have Undiagnosed Hypertension and Unstable CAD

Hypertension is prevalent, underdiagnosed, and significantly associated with the presence of unstable coronary artery disease (CAD), shows a prospective study of healthy, middle-aged, male master endurance athletes such as runners, cyclists, and swimmers.

More than a quarter of athletes were found to have resting hypertension, and in those with high normal blood pressure, more than 50% had abnormal blood pressure parameters.

The study also found that systolic blood pressure (SBP) was the best predictor of CT coronary abnormalities in these athletes.

Cardiovascular Evaluation

Presenting at this week’s British Cardiovascular Society (BCS) virtual meeting, Dr Gemma Parry-Williams, St George’s University of London, said: “These findings suggest that recommendations for cardiovascular evaluation of master athletes should consider a low threshold for exercise testing and ambulatory blood pressure monitoring for those with resting hypertension and even high normal blood pressure.”

Current physical activity guidelines recommend a minimum of 30 minutes of moderate physical activity per day, 5 days per week, or 25 minutes of vigorous activity per day for 3 days per week. Endurance athletes exceed the usual recommendations for exercise by 15 to 20-fold.

There is known to be a reverse J-shaped dose–response relationship between lifetime exercise exposure and cardiovascular morbidity, but in some individuals who engage in endurance sports exercise at levels far beyond the recommendations, some of the benefits of exercise are lost, noted Dr Parry-Williams in a paper published earlier this year.

Risk Factor

Dr Martin Halle, is a specialist in internal medicine, cardiology and sports medicine, at the Technical University of Munich, Germany, as well as president, European Association of Preventive Cardiology (EAPC). Commenting on the work, he said, “I think that in general, hypertension in master athletes should be clearly regarded as a risk factor. It is often overlooked or neglected as these individuals are very fit, look healthy and themselves neglect elevated blood pressure levels and do not want to be treated by medication,” he noted.