Hypertension in athletes is underrecognized medical condition. It calls for screening for hypertension and unique principles that are applied for its management in this special group

1. Hypertension
in Athletes
Dr Syed Raza
MD,MRCP,FRCP, CCT (UK),FACC, FESC, FESCVI
Consultant Cardiologist
Awali Hospital
Bahrain

3. World's fittest 96-year-old, Charles Eugster

7. Hypertension in Athletes and Sportsmen

8. Objectives
• 1. Size of the problem
• 2. Evaluation
• 3. Recommendations for sports participation
• 4. Management of blood pressure in athletes

9. Hypertension is the most common cardiovascular condition
affecting athletes.
The fundamental parameters defining hypertension in both adults
and children do not differ in athletes.
Usually identified in sports pre-participation medical evaluation
Requires a little different management strategy

12. Prevalence of HPN in athletes is variable. Large
studies = 3%

13. 1. Prevalence 3%
2. All hypertensive
athletes achieved
optimal blood pressure
control.
3. Family history of HPN
and high BMI were
main risk factors
4. Life style
modification was
mainstay of treatment
to control BP in
majority

14. Measurement of blood
pressure
During a pre-participation examination, a trained clinician
should measure a resting blood pressure (BP) while the
1.Athlete is seated and relaxed, ideally for a period of five
minutes prior to the measurement.
2. Some athletes have large, muscular arms and an
appropriately sized BP cuff should be used.
3. If a properly measured BP is elevated at the first
examination, sports participation is permitted but a second
visit should be scheduled within a few weeks

17. Target Organ Damage (TOD)

18. Associated
Clinical
Conditions
1. AF
2. Ischemic heart disease
3. Heart Failure
4. Cerebrovascular disease
5. Peripheral vascular disease
6. Hypertensive nephropathy
7. Hypertensive retinopathy

21. Power Sports

22. Edward Hall(World’s strongest man -2017)-
Deadlift championship

23. BP- 300/180 mmHg !!

24. General guideline for exercise and training
for hypertensive athletes and sportsmen
1. Warm up and cool down
2. Avoid heavy weight lifting
3. Avoid lifting weights above head
4. Avoid physically demanding static / isometric exercises
5. Prolonged breath hold and Valsalva maneuver to be discouraged.

25. Management of
hypertension in athletes

26. Management of hypertension
in athletes
• 1. Non -pharmacological interventions
• 2. Medical therapy

27. Nonpharmacologic interventions
1. Weight loss 10 lb (4.5 kg) weight loss can reduce systolic blood pressure (SBP) 5 to 20 mmHg
2. Sodium restriction (limit salt added to food; avoid processed foods with high sodium content) 2
to 4 g/day can reduce SBP 2 to 8 mmHg
3. DASH diet (diet high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and
nuts; low in sweets, sugar-sweetened beverages, and red meats) can result in SBP reduction 8 to 14
mmHg
4. Alcohol restriction (no more than two drinks per day for men or one per day for women)
can lead to SBP reduction 2 to 4 mmHg
5. Aerobic exercise activity (three to four sessions per week of at least moderate intensity, each
session lasting at least 40 minutes) can cause SBP reduction 4 to 9 mmHg
6. Stress Management

28. Medical
therapy
If nonpharmacologic modifications fail to
reduce BP adequately in an athlete with
persistent hypertension, medical therapy is
required
The ideal medication controls BP without
compromising exercise capacity.
There is no fundamental difference in the
approach to the medical therapy of
hypertension in athletes compared with the
general population.

29. Choice of anti-
hypertensive
drugs
1.Review of list of prohibited drugs/medications (World
Anti-Doping Association)
2.ACEI and ARB preferred first line as they do not
interfere with exercise performance. C/I= Reproductive
age female athletes.
3. Calcium channel blocker ( not rate limiting) as second
choice
4. Beta blocker to be avoided = a. HR <50/mt b. Heart
blocks c. considered doping agent in sports like shooting
and archery as may mask tremors.
5.Diuretics should be avoided / banned as they mask
performance enhancing drugs and interfere in sports due
to frequent urination.

31. Persistent
hypertension
Athletes with hypertension that has persisted for
a longer period (6 to 12 months) or that has not
responded to lifestyle modifications and
pharmacotherapy should be assessed with an
echocardiogram.
The echocardiogram distinguishes between
pathologic changes associated with chronic
hypertension and normal adaptations in
athletes.
Athlete Heart = Eccentric or concentric LVH
with increased LV volume
Hypertension = Concentric LVH with reduced
LV volume

32. During
Competition
Generally, antihypertensive medications
should be continued during competition. If
an appropriate medication is chosen, there
is no need to withhold it.
Diuretics and beta- blocker should be
avoided
As a general rule, any new medication
should be given for at least one week prior
to any competitive event to help avoid any
unanticipated problems.

33. Medications and
Supplements that
can exacerbate
Hypertension or its
complications
• Human growth hormone, Androgen
hormones, Nonsteroidal anti-inflammatory
drugs
• Stimulants can increase BP : caffeine,
nicotine, ephedrine-containing over-the-
counter decongestants, ephedrine containing
herbal remedies, and amphetamines
• Creatine is the most widely used supplement
that may exacerbate the harmful effects of
hypertension, specifically renal function.

34. Prognosis
• The potential long-term complications from
hypertension in athletes are thought to be
similar to those in the general population, and
include myocardial infarction, stroke, renal
failure, and death
• Hypertension is not recognized as a cause of
exertional sudden cardiac arrest.
• LVH if present should be differentiated for
underlying etiology

35. Summary
Hypertension is one of the commonest
medical problems associated with athletes
Prevalence is very much dependent on cut
off threshold for diagnosis
Risk assessment is important to guide sports
participation and blood pressure management
Clear guideline exists on choice of medication