High blood pressure response to exercise predicts future development of hypertension in young athletes
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Aims: Due to superior exercise performance, athletes show higher blood pressure (BP) at peak exercise compared to untrained individuals. Thus, higher reference values for peak exercise systolic and diastolic BP were reported specifically for athletes. However, the prognostic significance of high blood pressure response (HBPR) to exercise has not yet been clarified in this population. Methods and results: One hundred and forty-one normotensive athletes with HBPR to exercise were compared to 141 normotensive athletes with normal blood pressure response (NBPR) to exercise, matched for gender, age, body size, and type of sport. All athletes were followed up for 6.5 ± 2.8 years. Over follow-up, no cardiac events occurred; 24 athletes were diagnosed essential hypertension (8.5%). Specifically, 19 (13.5%) belonged to the HBPR compared with 5 (3.5%) in the NBPR group (P = 0.003). Kaplan-Meier analysis confirmed that the incidence of hypertension during follow-up was higher in the HBPR group (log-rank χ2P-value = 0.009). Multivariable analysis by Cox proportional hazard survival model showed that resting BP and HBPR at baseline evaluation were the strongest predictors of incident hypertension (χ2 for the model 30.099; P < 0.001). Specifically, HBPR was associated with a hazard ratio of 3.6 (95% confidence interval 1.3-9.9) of developing hypertension. Over follow-up exercise capacity, as well as morphologic and functional cardiac parameters in athletes from both groups did not change significantly. Conclusion: The present study showed that an exaggerated BP response to exercise increased the risk for incident hypertension in highly trained and normotensive athletes over a middle-term period.
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Exaggerated blood pressure responses to exercise, especially submaximal exercise, independently predict future hypertension and cardiovascular illness and death.
“Notably, exaggerated exercising BP responses, particularly to submaximal exercise [19, 20], are a robust, independent predictor of future hypertension [21–23] and cardiovascular (CV) morbidity and mortality [20, 24, 25].”
From Habitual preexercise caffeine supplementation prevents exercise training-induced attenuation of exercising systolic blood pressure and double product (2025) · cites this paper as [21]
A hypertensive BP response during exercise is an independent predictor of hypertension, regardless of resting BP levels in the general population and among athletes.
“A hypertensive BP response during exercise is an independent predictor of hypertension, regardless of resting BP levels in the general population29 and among athletes.30”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [30]
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“30 Identification and safety netting of such athletes with advice regarding BP monitoring and control could mitigate progression of atherosclerosis, development of high-risk plaques and the risk of adverse events.”
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Unicuique suum: the proper discipline for the proper athlete
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Reply to the letter to the editor
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- Authors
- Caselli, S., Serdoz, A., Mango, F., Lemme, E., Vaquer Seguì, A., Milan, A., Attenhofer Jost, C., Schmied, C., Spataro, A., & Pelliccia, A.
- Affiliations
- Hirslanden Klinik Im Park (CH)
- Institute of Sports Medicine and Science, Rome, Largo Piero Gabrielli, Roma, Italy
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Cardiovascular Center Zürich, Hirslanden Klinik im Park, Seestrasse 220, Zürich, Switzerland
- University Heart Center, Rämistrasse 100, Zürich, Switzerland
- Corresponding author
- Caselli, Stefano
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-12-22
- Volume
- 40
- Issue
- 1
- Pages
- 62-68
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2906354124
- Cited by
- 109
- References
- 40
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 19 · 2023: 15 · 2022: 16 · 2021: 18 · 2020: 14 · 2019: 10
- FWCI
- 7.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Funders
- Italian National Olympic Committee
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- hypertension incidence, youth athletes, essential hypertension, resting blood pressure, exercise capacity, cardiovascular risk prediction
- MeSH terms
- Adult, Blood Pressure, Female, Follow-Up Studies, Humans, Hypertension, Male, Prognosis, Exercise, Young Adult
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