Abstract
Hypertension continues to be the most common cardiovascular disorder in the USA and worldwide. While generally considered a disorder of aging individuals, hypertension is more prevalent in athletes and the active population than is generally appreciated. The timely detection, diagnosis, and appropriate treatment of hypertension in athletes must focus on both adequately managing the disorder and ensuring safe participation in sport while not compromising exercise capacity. This publication focuses on appropriately diagnosing hypertension, treating hypertension in the athletic population, and suggesting follow-up and participation guidelines for athletes.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322.
World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011.
De Matos LD, Caldeira Nde A, Perlingeiro Pde S, et al. Cardiovascular risk and clinical factors in athletes: 10 years of evaluation. Med Sci Sports Exerc. 2011;43(6):943–50.
Kaplan NM, Gidding SS, Pickering TG, et al. Task force 5: systemic hypertension. J Am Coll Cardiol. 2005;45:1346–58.
Black HR, Sica D, Ferdinand K, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 6: hypertension: a scientific statement from the American Heart Association and the American College of Cardiology. Circulation. 2015;132(22):e298–302. Quick position statement by the AHA/ACC for participation recommendations for athletes with hypertension.
Karpinos AR, Roumie CL, Nian H, et al. High prevalence of hypertension among collegiate football athletes. Circ Cardiovasc Qual Outcomes. 2013;6(6):716–23. Sheds light into the prevalence of hypertension among collegiate football players.
Allen TW, Vogel RA, Lincoln AE, et al. Body size, body composition, and cardiovascular disease risk factors in NFL players. Phys Sportsmed. 2010;38(1):21–7.
Berge HM, Gierdalen GF, Andersen TE, et al. Blood pressure in professional male football players in Norway. J Hypertens. 2013;31(4):672–9. Describes a prevalence of hypertension among professional athletes in a sport outside of ASF.
Kouidi E, Fahadidou-Tsiligiroglou A, Tassoulas E, et al. White coat hypertension detected during screening of male adolescent athletes. Am J Hypertens. 1999;12(2 Pt 1):223–6.
Baron S, Rinsky R. National Institute for Occupational Safety and Health. NFL mortality study. Available at: http://www.cdc.gov/niosh/pdfs/nflfactsheet.pdf. Accessed July 25, 2016.
Leddy JJ, Izzo J. Hypertension in athletes. J Clin Hypertens. 2009;11(4):226–33.
Asplund C. Treatment of hypertension in athletes: an evidence-based review. Phys Sportsmed. 2010;38(1):37–44.
Handler J. The importance of accurate blood pressure measurement. Perm J. 2009;13(3):51–4.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.
McCambridge TM, Benjamin HJ, Brenner JS, et al. Athletic participation by children and adolescents who have systemic hypertension. Pediatrics. 2010;125(6):1287–94.
Pickering Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1.
Andersen MJ, Khawandi W, Agarwal R. Home blood pressure monitoring in CKD. Am J Kidney Dis. 2005;45:994.
Parati G, Pickering TG. Home blood-pressure monitoring: US and European consensus. Lancet. 2009;373:876.
Stergiou GS, Skeva II, Baibas NM, et al. Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. J Hypertens. 2000;18:1745.
Niiranen TJ, Johansson JK, Reunanen A, Jula AM. Optimal schedule for home blood pressure measurement based on prognostic data: the Finn-Home Study. Hypertension. 2011;57:1081.
Parati G, Stergiou GS, Asmar R, et al. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24:779.
Stiefel EC, Field L, Replogle W, et al. The prevalence of obesity and elevated blood pressure in adolescent student athletes from the state of Mississippi. Orthop J Sports Med. 2016 Feb 19;4(2). Great publication linking obesity with hypertension even in young athletes.
Jago R, Harrell JS, McMurray RG, et al. Prevalence of abnormal lipid and blood pressure values among an ethnically diverse population of eighth-grade adolescents and screening implications. Pediatrics. 2006;117(6):2065–73.
Tucker AM, Vogel RA, Lincoln AE, et al. Prevalence of cardiovascular disease risk factors among National Football League players. JAMA. 2009;301(20):2111–9.
Feairheller DL, Aichele KR, Oakman JE, et al. Vascular health in American football players: cardiovascular risk increased in division III players. Int J Vasc Med. 2016; Epub 2016 Jan 24. Highlights the potentially elevated cardiovascular risk in ASF players.
Rice TB, Dunn RE, Lincoln AE, et al. Sleep-disordered breathing in the National Football League. Sleep. 2010;33(6):819–24.
Berge HM, Isern CB, Berge E. Blood pressure and hypertension in athletes: a systematic review. Br J Sports Med. 2015;49(11):716–23. An excellent review looking to determine the true prevalence of hypertension in athletes.
Berge HM, Andersen TE, Solberg EE, Steine K. High ambulatory blood pressure in male professional football players. Br J Sports Med. 2013;47(8):521–5.
Shah SA, Chu BW, Lacey CS, et al. The impact of acute energy drink consumption on blood pressure parameters: a meta-analysis. Ann Pharmacother. 2016 Jun 23. pii: 1060028016656433. [Epub ahead of print]
Wilens TE, Hammerness PG, Biederman J, et al. Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2005;66(2):253–9.
Kozor R, Grieve SM, Buchholz S, et al. Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals. PLoS One. 2014;9(4):e89710.
Riebe D, Fernahall B, Thompson PD. The blood pressure response to exercise in anabolic steroid users. Med Sci Sports Exerc. 1992;24(6):633–7.
Boldo A, White WB. Blood pressure effects of the oral contraceptive and postmenopausal hormone therapies. Endocrinol Metab Clin North Am. 2011;40(2):419–32.
Pope JE, Anderson JJ, Felson DT. A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Intern Med. 1993;153(4):477–84.
Wolk R, Shamsuzzaman AS, Svatikova A, et al. Hemodynamic and autonomic effects of smokeless tobacco in healthy young men. J Am Coll Cardiol. 2005;45(6):910–4.
Huang SH, Johnson K, Pipe AL. The use of dietary supplements and medications by Canadian athletes at the Atlanta and Sydney Olympic Games. Clin J Sport Med. 2006;16:27–33.
Tricker R. Painkilling drugs in collegiate athletics. J Drug Educ. 2000;30:313–24.
Mahler N. Misuse of drugs in recreational sports. Ther Umsch. 2001;58(4):226–31.
Pellica A. Athlete’s heart and hypertrophic cardiomyopathy. Curr Cardiol Rep. 2000;2:166–71.
Messerli FH, Ventura HO, Amodeo C. Osler’s maneuver and pseudohypertension. N Engl J Med. 1985;312(24):1548–51.
Hulsen HT, Nijdam ME, Bos WJ, et al. Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. J Hypertens. 2006;24:1027–32.
McEniery CM, Yasmin, Wallace S, et al. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension. 2005;46:221–6.
Wilkinson IB, Franklin SS, Hall IR, et al. Pressure amplification explains why pulse pressure is unrelated to risk in young subjects. Hypertension. 2001;38:1461–6.
Mazic S, Suzic Lazic J, Dekleva M, et al. The impact of elevated blood pressure on exercise capacity in elite athletes. Int J Cardiol. 2015;180:171–7.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. Most recent recommendations for treating hypertension in adults.
Carre F, Handschuh R, Beillot J, et al. Effects of captopril chronic intake on the aerobic performance and muscle strength of normotensive trained subjects. Int J Sports Med. 1992;13(4):308–12.
D’Este D, Giada F, Sartori F, et al. The effects of enalapril on basal arterial pressure at rest and during exercise and on cardiac performance in hypertensive athletes. G Ital Cardiol. 1990;20(10):935–9.
Palla M, Ando T, Androulakis, et al. Renin-angiotensin system inhibitors vs other antihypertensives in hypertensive blacks: a meta-analysis. J Clin Hypertens. 2016. doi:10.1111/jch.12867. [Epub ahead of print]
Brown NJ, Ray WA, Snowden M, et al. Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clin Pharmacol Ther. 1996;60:8–13.
Kaplan NM. The CARE study: a postmarketing evaluation of ramipril in 11,100 patients. Clin Ther. 1996;18:658–70.
Li EC, Heran BS, Wright JM. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension. Cochrane Database Syst Rev. 2014;22(8)
Barrow MW, Clark KA. Heat-related illnesses. Am Fam Physician. 1998;58(3):749–56. 759.
Beavers CJ, Dunn SP, Macaulay TE. The role of angiotensin receptor blockers in patients with angiotensin-converting enzyme inhibitor-induced angioedema. Ann Pharmacother. 2011;45(4):520–4.
Product Information: COZAAR(R) oral tablets, losartan potassium oral tablets. Merck & Co., Inc., Whitehouse Station, NJ, 2005.
Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med. 1993;328(13):914.
Sareli P, Radevski IV, Valtchanova ZP, et al. Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa. Arch Intern Med. 2001;161(7):965.
Heffernan KS, Jae SY, Wilund KR, et al. Racial differences in central blood pressure and vascular function in young men. Am J Physiol Heart Circ Physiol. 2008;295:H2380–7.
Pool PE, Seagren SC, Salel AF. Effects of diltiazem on serum lipids, exercise performance and blood pressure: randomized, double blind, placebo-controlled evaluation for systemic hypertension. Am J Cardiol. 1985;56(16):86II–91II.
Agostini P, Doria E, Berti M, et al. Exercise performance in patients with uncomplicated essential hypertension. Effects of nifedipine-induced acute plod pressure reduction. Chest. 1992;101(6):1591–6.
Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384–95.
WADA Publishes 2016 Prohibited List (September 29, 2015). World Anti-Doping Agency. 2015. Web. Accessed July 29, 2016. Very important reference to be familiar with if treating athletes with any condition.
Mitchell JH, Haskell W, Snell P, Van Camp SP. Task Force 8: classification of sports. J Am Coll Cardiol. 2005;45(8):1367–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Drs. Schleich, Smoot, and Ernst declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action
Rights and permissions
About this article
Cite this article
Schleich, K.T., Smoot, M.K. & Ernst, M.E. Hypertension in Athletes and Active Populations. Curr Hypertens Rep 18, 77 (2016). https://doi.org/10.1007/s11906-016-0685-y
Published:
DOI: https://doi.org/10.1007/s11906-016-0685-y