Hypertension in Special Populations: Athletes

Rosa Maria Bruno; Giulia Cartoni; Stefano Taddei

Disclosures

Future Cardiol. 2011;7(4):571-584. 

In This Article

Future Perspective

In the near future it will be important to achieve an exact definition of the cardiovascular positive and negative effects of different sports on cardiovascular outcome. At the present time it is accepted that aerobic exercise is beneficial both for healthy individuals and patients, but no precise determination of the prognostic value of the specific type of sport and the level of intensity is available. Another factor to be considered in athletes is the impact of competition and the related emotional load. This factor may have a different weight in each individual, but in the light of the relevance of stress in cardiovascular disease,[76] it is conceivable that certain kinds of personality could be exposed to the detrimental effect of the competition-related emotional state.

Another crucial issue involves the need for a better understanding of the physiopathology of hypertension in athletes. Given that regular aerobic physical activity lowers blood pressure values and cardiovascular risk, the hypertensive athlete is potentially an ideal model to establish the mechanisms involved in determination of high blood pressure values. In this context, it will be of crucial interest to assess genetic interaction with exercise, in order to further establish any possible role of physical activity in the development of essential hypertension.

The exact determination of target blood pressure values in athletes needs to be further explored. At the moment there is little evidence that the classical limit of 140/90 mmHg can define hypertension in this special population. Since no prospective study has ever been performed in this special population, it can be speculated that in athletes a different cut off can be considered. Given the benefit of dynamic exercise per se on cardiovascular risk and the low prevalence of other major risk factors (smoking, hypercholesterolemia, diabetes) in sports practitioners, higher blood pressure values in athletes could perhaps be acceptable.

A final area of research will seek to establish the impact of pharmacological treatment on sports performance. At the present time we consider renin-angiotensin system blockers and calcium-antagonists as first choice drugs for the treatment of hypertension in athletes, but evidence concerning their impact on physical activity and long-term cardiovascular effects is still incomplete.

In conclusion, considering the increasing number of people who perform physical activity in general, and competitive sports in particular, more research is called for in order to explore this area of interest which, at the present time, gives rise to many hypotheses, but very few definitive statements.

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