The most common cardiovascular disease that is detected during a preliminary physical assessment in athletes is arterial hypertension. The specificity of this contingent of patients is that the antihypertensive therapy is not the standard one applied when diagnosing high blood pressure. The reason is that some of the medications that are used as a first line can worsen the physical form and accordingly compromise performance.
To date, there are still no accurate statistics to show whether the incidence of hypertension in active athletes is higher than in non-exercising people. According to some studies, the incidence of high blood pressure is up to 50% lower in athletes than in the general population.
Elevated blood pressure is associated with the body’s efforts to meet increased demands for blood (cardiac output) to meet the metabolic demands of working muscles.
A retrospective study showed an increased incidence of arterial hypertension in specific sports, one of which is American football. 113 respondents participated in the study, and in them, a significant increase in both systolic and diastolic pressure was found at the end of the active season compared to the beginning. 47% of the study participants at the end of the season had registered blood pressure levels corresponding to prehypertension and 14% corresponded to values that were the first degree of hypertension.
A predominance of male athletes with high blood pressure was also found, in contrast to the less common female gender. The impact of taking some commonly used supplements is still being studied. Circulation includes growth hormone, androgenic hormones (eg, anabolic steroids), erythropoietin, and stimulants such as caffeine and ephedrine. Creatinine is the most widely used “stimulant” or nutritional supplement that is relevant to kidney function, especially in individuals with kidney disease and impaired filtration function.
The kidneys have a direct relationship with the regulation of blood pressure, and accordingly, the deterioration of their function can also affect blood pressure – with a corresponding increase in its values. This is the reason why limiting creatine intake is recommended for athletes.
Another important factor in the supplements most often taken by athletes is anabolic hormones. Testosterone leads to vasoconstriction of the vessels. Taking erythropoietin is associated with the stimulation of the formation of more red blood cells, which in turn is associated with the binding of more oxygen and improved cellular respiration. However, erythropoietin also causes an increase in blood pressure in patients with chronic renal failure.
What is the behavior of athletes with elevated blood pressure?
If there is no damage to target organs – kidneys, blood vessels, heart, as well as in the case of diagnosed first and second-degree arterial hypertension, no restrictions on sports activities are imposed. In contrast, in the presence of damage to the target organs, a temporary suspension of sports activity is required until hypertension is controlled.
The temporary cessation of sports activity requires, after blood pressure regulation, to start with basic training, gradually increasing the load.
Controversy is ongoing regarding whether to initiate drug treatment in athletes with first-degree arterial hypertension. Earlier initiation of treatment may not only prevent the development of more severe hypertension but may also prevent long-term target organ damage.
It is important to note that untreated hypertension can reduce physical capacity due to deterioration of left ventricular diastolic filling. It is inappropriate to prescribe diuretics and beta-blockers.
Bibliography:
1. “Arterial hypertension in athletes”, L. Demirevska, I. Daskalov; Medical Magazine, no. 64, 04.2019
2. Hypertension in athletes, Leddy JJ, Izzo J., Clinical Hypertens, 2009, April
