Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners
Open accessAbstract
Marathon runners demonstrate a high incidence of coronary artery plaque; however, studies on runners with exercise-induced hypertension (EIH) are sparse. We aimed to investigate the prevalence of coronary artery plaque among marathon runners with EIH. Veteran male marathon runners (≥40 and <60 years) underwent an exercise stress test. They were divided into 2 groups: normal blood pressure group (NBPG, n = 22), with resting systolic blood pressure (SBP)/diastolic blood pressure <140/90 mm Hg and maximal exercise SBP <210 mm Hg, and EIH group (EIHG, n = 28), with resting blood pressure <140/90 mm Hg and maximal exercise SBP ≥210 mm Hg. Coronary artery plaque and stenosis were compared using multi-detector computed tomography. The proportion of subjects with a coronary artery calcium (CAC) score ≥10 or ≥100 units, 1 or ≥2 plaques, or plaques in ≥2 blood vessels was higher in the EIHG than in the normal blood pressure group (NBPG) (P<.05). The absolute CAC score was higher in the EIHG (42.6 ± 67.8) than in the NBPG (2.8 ± 6.0; P < .05). The CAC score distribution was higher in the EIHG (5–300 units) than in the NBPG (P < .05). The prevalence of coronary plaques and maximal luminal artery stenosis was higher in the EIHG than in the NBPG (P < .05). The EIHG showed 12 cases of stenosis, whereas the NBPG showed only 1 case (P < .05). In marathon runners, EIH was associated with increased prevalence of coronary artery plaques and could be a new risk factor for coronary artery plaque formation. Therefore, preventive measures and EIH monitoring using an exercise stress test, alongside multi-detector computed tomography, are recommended.
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In that prior study, these athletes demonstrated a high prevalence of CAC ≥10 or ≥100 AU, a greater number of coronary plaques, a higher number of vessels affected, and a higher prevalence of luminal reduction by plaques compared with athletes with a normal BP response.
“These athletes demonstrated a high prevalence of CAC ≥10 or ≥100 AU, a greater number of coronary plaques, a higher number of vessels affected, and a higher prevalence of luminal reduction by plaques compared with athletes with a normal BP response.28”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [28]
A prior smaller study of 50 normotensive master athletes revealed that 28 exhibited a hypertensive BP response.
“A prior smaller study of 50 normotensive master athletes revealed that 28 exhibited a hypertensive BP response.”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [28]
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Cites
Lauer, M. S., Pashkow, F. J., Harvey, S. A., Marwick, T. H., & Thomas, J. D. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00388-6 · Cited by 127 · see citing works
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Research works printed but not linked: 24
- [1]Villella M Villella A Exercise and cardiovascular diseases. Kidney Blood Press Res 2014; 39: 147– 53. 25117881
- [2]Humphrey R Bartels MN Exercise, cardiovascular disease, and chronic heart failure. Arch Phys Med Rehabil 2001; 82: S76– 81. 11239339
- [3]Church TS Blair SN Cocreham S Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010; 304: 2253– 62. 21098771 PMC3174102
- [4]Vlachopoulos C Kardara D Anastasakis A Arterial stiffness and wave reflections in marathon runners. Am J Hypertens 2010; 23: 974– 9. 20489686
- [5]Abdulla J Nielsen JR Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 2009; 11: 1156– 9. 19633305
- [7]Allison TG Cordeiro MA Miller TD Prognostic significance of exercise-induced systemic hypertension in healthy subjects. Am J Cardiol 1993; 83: 371– 5. 10072226
- [8]Kim YJ Kim CH Park KM Excessive exercise habits of runners as new signs of hypertension and arrhythmia. Int J Cardiol 2016; 217: 80– 4. 27179212
- [9]Kim YJ Park Y Kang DH Excessive exercise habits in marathoners as novel indicators of masked hypertension. Biomed Res Int 2017; 2017: 1342842. 28293624 PMC5331299
- [10]Kurl S Laukkanen JA Rauramaa R Systolic blood pressure response to exercise stress test and risk of stroke. Stroke 2001; 32: 2036– 41. 11546894
- [11]Mundal R Kjeldsen SE Sandvik L Exercise blood pressure predicts mortality from myocardial infarction. Hypertension 1996; 27: 324– 9. 8698433
- [12]Stewart KJ Sung J Silber HA Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens 2004; 17: 314– 20. 15062884
- [13]Singh JP Larson MG Manolio TA Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation 1999; 99: 1831– 6. 10199879
- [14]Haskell WL Lee IM Pate RR Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39: 1423– 34. 17762377
- [15]Merghani A Maestrini V Rosmini S Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation 2017; 136: 126– 37. 28465287
- [16]Tsiflikas I Thomas C Fallmann C Prevalence of subclinical coronary artery disease in middle-aged, male marathon runners detected by cardiac CT. Rofo 2015; 187: 561– 8. 25831468
- [17]Gibbons RJ Balady GJ Beasley JW ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation 1997; 96: 345– 54. 9236456
- [18]James PA Oparil S Carter BL 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507– 20. 24352797
- [19]Kim YJ Shin YO Lee YH Effects of marathon running on cardiac markers and endothelin-1 in EIH athletes. Int J Sports Med 2013; 34: 777– 82. 23444087
- [20]Kim YJ Kim CH Shin KA Cardiac markers of EIH athletes in ultramarathon. Int J Sports Med 2012; 33: 171– 6. 22261825
- [21]Maron BJ Sudden death in young athletes. N Engl J Med 2003; 349: 1064– 75. 12968091
- [22]Wilson MF Sung BH Pincomb GA Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol 1990; 66: 731– 6. 2399891
- [23]Kojda G Hambrecht R Molecular mechanisms of vascular adaptations to exercise: physical activity as an effective antioxidant therapy? Cardiovasc Res 2005; 67: 187– 97. 15935334
- [24]Suzuki K Nakaji S Yamada M Impact of a competitive marathon race on systemic cytokine and neutrophil responses. Med Sci Sports Exerc 2003; 35: 348– 55. 12569227
- [25]Kim D Ha JW Hypertensive response to exercise: mechanisms and clinical implication. Clin Hypertens 2016; 22: 17. 27468357 PMC4962449
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O’Driscoll, J., Parry-Williams, G., Moser, J., Vlahos, I., Obaid, D., Basu, J., Finocchiaro, G., Fyyaz, S., MacLachlan, H., Marwaha, S., et al. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-111347
“A prior smaller study of 50 normotensive master athletes revealed that 28 exhibited a hypertensive BP response.”
- Authors
- Kim, C.-H., Park, Y., Chun, M. Y., & Kim, Y.-J.
- Affiliations
- Soonchunhyang University (KR)
- Inje University (KR)
- Sungshin Women's University (KR)
- Corresponding author
- Kim, Young-Joo
- Venue
- Medicine
- Published
- 2020-04
- Volume
- 99
- Issue
- 17
- Pages
- e19911
- ISSN
- 0025-7974 (ISSN-L)
- 1536-5964
- PMC
- PMC7440091
- OpenAlex
- W3017817067
- Cited by
- 24
- References
- 1
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 2
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2017S1A5A2A03068634)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- exercise-induced hypertension, marathon runners, coronary plaque, coronary artery calcium, coronary artery stenosis, middle-aged men, exercise stress testing, cardiovascular risk factors, multidetector computed tomography
- MeSH terms
- Adult, Coronary Artery Disease, Exercise Test, Female, Humans, Hypertension, Male, Middle Aged, Risk Factors, Running, Tomography, X-Ray Computed, Exercise, Prevalence, Statistics, Nonparametric, Athletes, Plaque, Atherosclerotic
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