How to manage hypertension in teen athletes?

Management of Hypertension in Teen Athletes

Teen athletes with hypertension should be allowed to participate in most sports with appropriate monitoring and treatment, but those with stage 2 hypertension should be restricted from high-static sports until blood pressure is controlled. 1

Diagnosis and Assessment

Before making management decisions for teen athletes with hypertension:

• Confirm diagnosis with multiple BP readings on separate occasions

• Use proper cuff size and measurement technique

• Consider ambulatory BP monitoring to exclude white coat hypertension 1

• Categorize severity:

  • Prehypertension: 120/80 to 139/89 mmHg
  • Stage 1 hypertension: 140/90 to 159/99 mmHg
  • Stage 2 hypertension: ≥160/100 mmHg

• Screen for target organ damage:

  • Echocardiography to assess for left ventricular hypertrophy (LVH)
  • Retinal examination
  • Consider evaluation for sleep disorders 1

Sports Participation Guidelines

Prehypertension

• No restrictions on sports participation
• Encourage lifestyle modifications
• Monitor BP every 6 months 1

Stage 1 Hypertension

• If no end-organ damage or LVH:
  • May participate in all competitive sports
  • Monitor BP every 2-4 months during training 1
• If LVH or other cardiovascular disease present:
  • Restrict from high-static sports (classes IIIA to IIIC) until BP normalized 1
  • These include weightlifting, boxing, wrestling, and gymnastics

Stage 2 Hypertension

• Restrict from high-static sports until BP is controlled with lifestyle modification or drug therapy 1
• Refer to pediatric cardiologist or hypertension specialist for management 1

Treatment Approach

Non-Pharmacological Management (First-Line)

1. Physical Activity

   • Regular, non-competitive aerobic exercise helps reduce both systolic and diastolic BP 1
   • 30-60 minutes of moderate-to-vigorous physical activity most days

2. Dietary Modifications

   • Reduce sodium intake (with special consideration for athletes' hydration needs)
   • Increase potassium intake
   • Follow a well-balanced diet

3. Weight Management

   • Achieve and maintain healthy weight
   • Particularly important for obese athletes who are at higher risk for hypertension 1

4. Substance Avoidance

   • Screen for and eliminate substances that may increase BP:
     • Energy drinks and excessive caffeine
     • Over-the-counter decongestants
     • NSAIDs
     • Performance-enhancing drugs
     • Tobacco and alcohol 1

Pharmacological Management

If BP remains elevated despite lifestyle modifications:

• First-line medications for teens:

  • ACE inhibitors (like lisinopril) - effective in pediatric patients 2
  • ARBs
  • Calcium channel blockers
  • Thiazide diuretics (may require therapeutic exemption for competitive athletes) 1

• For teen athletes specifically:

  • Beta-blockers are generally avoided as they may impair exercise capacity
  • Consider medications that don't negatively impact athletic performance
  • Ensure medications are registered with appropriate sport governing bodies 1

Special Considerations for Athletes

1. Hydration and Sodium Balance

   • Athletes with high sweat rates may require additional salt-containing fluids despite hypertension 1
   • Balance sodium restriction for BP control with electrolyte needs during intense training

2. BP Response During Exercise

   • Both systolic and diastolic BP rise during resistance/static exercise
   • Monitor BP response to exercise in hypertensive athletes

3. Monitoring Schedule

   • Athletes with controlled hypertension: Check BP every 2-4 months
   • Athletes with medication changes: More frequent monitoring
   • Consider periodic exercise stress testing to assess BP response during exertion

Follow-up and Ongoing Management

• Regular BP monitoring during training season
• Annual echocardiography to monitor for development of LVH
• Adjust medications as needed based on BP control and athletic performance
• Re-evaluate eligibility for restricted sports as BP improves

By following these guidelines, teen athletes with hypertension can safely participate in sports while minimizing cardiovascular risk and optimizing performance.