From the Guidelines
Elevated systolic blood pressure in young athletes is most commonly caused by exercise-induced hypertension, which is a natural response to intense physical activity, but other factors such as "athlete's heart," overtraining syndrome, performance-enhancing substances, and underlying medical conditions can also contribute. The causes of elevated systolic blood pressure in young athletes can be multifaceted, including:
- Exercise-induced hypertension, which is a normal response to physical activity, as seen in dynamic exercise where systolic blood pressure increases significantly, and diastolic pressure decreases 1
- "Athlete's heart," a condition where the heart muscle thickens, potentially leading to higher baseline blood pressure
- Overtraining syndrome, which can lead to increased blood pressure due to chronic stress on the body
- Performance-enhancing substances, such as stimulants, anabolic steroids, and certain supplements, which can increase blood pressure
- Poor hydration practices, high sodium intake, genetic predisposition, and underlying medical conditions like kidney disease or hormonal disorders
- Stress and anxiety related to competition, which can temporarily elevate blood pressure
According to the American Heart Association and the American College of Cardiology, it is reasonable that athletes with stage 2 hypertension should be restricted from high static sports until hypertension is controlled by either lifestyle modification or drug therapy 1. Additionally, the clinical practice guideline for screening and management of high blood pressure in children and adolescents recommends that children and adolescents with hypertension should have their blood pressure measured annually, and those with stage 2 hypertension should be treated to lower their blood pressure below stage 2 thresholds before participation in competitive sports 1.
It is essential to evaluate and manage hypertension in young athletes to prevent long-term cardiovascular risks and ensure their safety during physical activity. Treatment typically begins with non-pharmacological approaches, such as optimizing diet, ensuring adequate rest between training sessions, and stress management techniques, before considering medications that won't negatively impact athletic performance.
From the Research
Causes of Elevated Systolic Blood Pressure in Young Athletes
- Regular physical activity is a major component of isolated systolic hypertension in the young, as it produces favourable long-standing cardiovascular effects, including the improvement of arterial elasticity 2.
- Long-term training in aerobic sports is one main factor contributing to isolated systolic hypertension, as it increases stroke volume secondary to low heart rate and high arterial elasticity, causing an increase in peripheral pulse pressure 2.
- Endurance-trained athletes attain a greater exercise systolic blood pressure than in their untrained state and sedentary counterparts, but it is currently unknown what is considered a safe upper limit 3.
- Strength-trained athletes have higher blood pressure than endurance-trained athletes, and there is a trend towards a higher blood pressure in athletes training ≥10 h compared with others 4.
- High blood pressure response to exercise predicts future development of hypertension in young athletes, with an exaggerated blood pressure response to exercise increasing the risk for incident hypertension in highly trained and normotensive athletes over a middle-term period 5.
Physiological Characteristics of Highly Fit Individuals
- Highly fit individuals have physiological characteristics that distinguish them from sedentary individuals, including improved cardiovascular physiology and exercise blood pressure 3.
- The safety of high systolic blood pressure during exercise in highly fit subjects is not well established, and applying guidelines developed for a "normal" population to endurance-trained individuals appears unsupported at this time 3.
- Subclinical changes in left ventricular systolic and diastolic function can be detected even at blood pressure levels below the hypertensive range as currently defined, and blood pressure and adiposity are statistically significant determinants of left ventricular systolic and diastolic function 6.
Prevalence of Hypertension in Athletes
- The prevalence of hypertension in athletes varies considerably, partly due to variations in methodology, but type and intensity of training may contribute towards higher blood pressure 4.
- Some studies have shown an association between high blood pressure and left ventricular hypertrophy in athletes, highlighting the importance of careful clinical assessment of all cardiovascular risk factors and target organ involvement 2, 4.