Hypertension and sports

Every 4 years the Olympic Games put health and athletics under the spotlight. It’s estimated that a quarter of the world’s population has hypertension. Perhaps counterintuitively this includes professional athletes and individuals involved in leisure time sports activities. Several studies have found a beneficial relationship between increased physical activity and reduced blood pressure. Consequently, physical exercise is often recommended by healthcare professionals to prevent, manage, and treat hypertension.¹

However, the prevalence of hypertension may vary from sport-to-sport and in some cases may even be higher in athletes competing in certain disciplines than in the general population. Hypertension is the most common medical condition in athletes and may raise concerns about its management and the individual’s eligibility for competitive sports.¹

The dual role of exercise in hypertension

Exercise is a well-established component in the prevention and management of hypertension. Regular physical activity helps reduce blood pressure by improving heart efficiency, reducing arterial stiffness, and promoting weight loss. However, for athletes, especially those involved in high-intensity sports, the relationship between exercise and blood pressure can be more complex.¹

The unique challenges of hypertension in athletes

Athletes face unique challenges when it comes to hypertension, and understanding these challenges is crucial for effective management:

1.     Masked hypertension and exercise-induced hypertension (EIH):

• Masked hypertension is where athletes experience normal blood pressure at rest but this is elevated during physical exertion or stress. This condition is particularly dangerous because it often goes undiagnosed and untreated.

• Exercise-induced hypertension (EIH) is characterized by elevated blood pressure during exercise. While occasional increases in blood pressure are normal during physical activity, sustained high blood pressure during or after exercise can indicate a predisposition to hypertension.

2.     Impact of performance-enhancing substances:

The use of performance-enhancing drugs, including steroids and stimulants, can significantly increase blood pressure. Athletes who use these substances are at a higher risk of developing hypertension.²

3.     Elite athletes and left ventricular hypertrophy (LVH):

A study to ascertain whether there was an association between high blood pressure and LVH concluded that while prevalence of hypertension in athletes varied considerably, the type and intensity of training might contribute towards higher BP. In addition, high BP may be associated with LVH.³

By addressing these specific challenges, athletes and their healthcare providers can better manage and mitigate the risks associated with hypertension, ensuring optimal performance and long-term health.

Recognising symptoms and risks

Symptoms of hypertension are often subtle and can be mistaken for other sports-related issues such as fatigue or overtraining. Common symptoms include headaches, dizziness, shortness of breath, and chest pain. Regular blood pressure measurement is essential for early detection, especially for athletes involved in high-intensity or endurance sports.⁴

What can athletes do to better manage the risks of hypertension?

• Regular BP monitoring - home blood pressure monitoring (HBPM) is a convenient and flexible way to both measure and track blood pressure, outside of the clinical setting.

• Lifestyle modifications - reducing salt, increasing potassium, and eating a balanced diet rich in fruits, vegetables, and whole grains are essential.⁴

• Medication – sometimes antihypertensive medications may be required. Athletes should work closely with healthcare providers to find suitable medications.

• Avoiding performance-enhancing substances – steering clear of substances that can elevate blood pressure, such as anabolic steroids, is crucial.²

• Stress management – mental stress can contribute to high blood pressure. Techniques such as mindfulness, meditation, and adequate rest are important for managing stress levels.

The roles of coaches and healthcare professionals

Coaches and healthcare professionals play a vital role in managing hypertension in athletes. Providing education on the importance of regular blood pressure measurement and healthy lifestyle choices is essential. Additionally, creating an environment where athletes feel comfortable discussing health concerns could lead to better management and prevention strategies.

In conclusion

Hypertension in sports is a multifaceted issue requiring a comprehensive approach to management. By understanding the unique risks associated with high-intensity exercise, performance-enhancing substances, and the possibility of physiological changes, athletes and their support teams can develop effective strategies to manage hypertension.

Regular blood pressure monitoring, lifestyle modifications, and appropriate medical interventions are key to ensuring that athletes maintain both their health and their competitive edge. By addressing hypertension proactively, athletes can continue to perform at their best while safeguarding their long-term cardiovascular health.