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Cited by 0Cardiovascular Effects of ExerciseBlood Pressure and Hypertension StudiesCardiovascular and exercise physiology

Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes

Open access
O’Driscoll, Jamie, Parry-Williams, Gemma, Moser, Joanna, Vlahos, Ioannis, Obaid, Daniel, Basu, Joyee, Finocchiaro, Gherardo, Fyyaz, Saad +16 more·2026·British Journal of Sports Medicine
DOI 10.1136/bjsports-2025-111347PMC PMC13479618
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Abstract

Objective: Recent studies have demonstrated a greater prevalence of coronary atherosclerosis in male masters endurance athletes, but the underlying contributors remain unclear. We explored the relationship between occult resting and exercise-induced hypertension with coronary atherosclerosis characteristics. Methods: 198 male masters endurance athletes with a low Framingham risk score (<10%) and no clinical diagnosis of hypertension underwent 24-hour ambulatory blood pressure (ABP) monitoring and exercise BP assessment. Coronary CT angiography assessed coronary artery calcification (CAC) score, luminal stenosis and high-risk plaque features. Results: Seventy-eight (39%) athletes were hypertensive on ABP monitoring and 93 (47%) demonstrated a hypertensive response to exercise. A CAC score of 1–99 Agatston units (AU), 100–399 AU and ≥400 AU was present in 94 (47%), 32 (16%) and 15 (8%) athletes, respectively. Twenty-four (12%) athletes had coronary stenoses >50%. Sixty-two athletes (31%) had calcified plaque, 32 (16%) had mixed plaque, 2 (1%) had non-calcified plaque and 26 (13%) had markers of high-risk plaque. Hypertension on ABP monitoring was significantly associated with a CAC score ≥100 AU (OR: 2.56; 1.08 to 6.04) and coronary stenosis >50% (OR: 2.92; 1.17 to 7.33). A hypertensive response to exercise was significantly associated with coronary stenosis >50% (OR: 4.72; 1.65 to 13.5) and the presence of high-risk plaque (OR: 3.27; 1.27 to 8.43). Conclusion: Masters male endurance athletes have a high prevalence of occult hypertension, which is associated with high-risk features of coronary atherosclerosis. Both ambulatory and exercise-induced hypertension are associated with a higher prevalence of atherosclerotic coronary artery disease in male endurance athletes. Early identification and timely clinical management of this classic cardiovascular disease risk factor may reduce the burden of coronary atherosclerosis in athletes.

AI snapshot

Written from the paper’s full text.

TL;DR

In 198 male masters endurance athletes with low Framingham risk and no known hypertension, occult ambulatory hypertension and exercise-induced hypertension were common and associated with coronary atherosclerosis, including stenosis and high-risk plaque. Both blood pressure phenotypes may identify athletes at higher coronary risk beyond resting clinic measurements.

Key findings

  • Seventy-eight athletes (39%) were hypertensive on 24-hour ambulatory blood pressure monitoring, and 70 (90%) of these had normal clinic blood pressure; 93 athletes (47%) had a hypertensive response to exercise (peak systolic BP ≥210 mm Hg).
  • Coronary CT angiography showed CAC 1–99 AU in 94 (47%), CAC 100–399 AU in 32 (16%), CAC ≥400 AU in 15 (8%), coronary stenosis >50% in 24 (12%), and high-risk plaque markers in 26 (13%).
  • Ambulatory hypertension was independently associated with CAC ≥100 AU (adjusted OR 2.56; 95% CI 1.08 to 6.04) and coronary stenosis >50% (adjusted OR 2.92; 95% CI 1.17 to 7.33).
  • A hypertensive response to exercise was independently associated with coronary stenosis >50% (adjusted OR 4.72; 95% CI 1.65 to 13.5) and high-risk plaque (adjusted OR 3.27; 95% CI 1.27 to 8.43), but not with CAC scores.

Methods

  • Prospective observational study: 220 male masters endurance athletes recruited February 2018–March 2019, with 198 completing all procedures; eligibility included males aged 40–65 years, endurance exercise ≥6 hours/week, Framingham risk score <10%, and no known hypertension.
  • Participants underwent physical examination, symptom-limited cycle ergometer cardiopulmonary exercise testing, 24-hour ambulatory BP monitoring, CT coronary calcium scoring, and coronary CT angiography; hypertension was defined by European Society of Cardiology ambulatory BP criteria, and a hypertensive response to exercise was defined as peak systolic BP ≥210 mm Hg.
  • Binary logistic regression calculated unadjusted and adjusted ORs for associations between hypertension and coronary outcomes, with adjustment for age, lifetime exercise dose, and resting clinic BP; alpha was 0.05.

Limitations

  • Stated: no matched controls were included; only men were studied; most athletes were Caucasian; diet, alcohol consumption, substance use, lipoprotein(a), inflammatory biomarkers, and polygenic risk for CAD were not explored; systolic BP–workload slope across exercise stages was not assessed; and fixed systolic BP thresholds may overestimate hypertensive response prevalence in highly trained endurance athletes.
  • Evident from the design: the cross-sectional observational design cannot establish causality or temporality between hypertension and coronary atherosclerosis.
  • The paper itself notes that the combined hypertension plus exercise-induced hypertension phenotype analysis was exploratory and should be interpreted cautiously.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bjsports-2025-111347

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 32 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    A high CAC is linked with an increased prevalence of adverse coronary events irrespective of fitness.

    “there is emerging evidence that a high CAC is linked with an increased prevalence of adverse coronary events irrespective of fitness.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Premisecitation

    Classic cardiovascular disease risk factors appear to be significant contributors to accelerated atherosclerotic coronary artery disease in male masters endurance athletes.

    “The cause of accelerated atherosclerotic CAD in male masters endurance athletes remains unknown;2 10 however, classic cardiovascular disease risk factors appear to be significant contributors.11”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [11] Berge, 2025, Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study, Eur Heart J Cardiovasc Imaging source

      The Discussion (page not provided) reports that age, systolic blood pressure, smoking history, and family history of CAD were associated with coronary artery calcification in middle-aged and older athletes. This supports a role for classic risk factors, but the study assessed associations with calcification, not whether those factors cause accelerated coronary artery disease. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    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.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] Kim, 2020, Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners, Medicine (Baltimore) source
  • Premisecitation

    There is a high prevalence of a hypertensive BP response when defined using a fixed systolic threshold.

    “given the high prevalence of a hypertensive BP response when defined using a fixed systolic threshold,31”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Janssens, 2025, Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum, Eur J Prev Cardiol source
  • Premisecitation

    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”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [29] source
    • cites [30] Caselli, 2019, High blood pressure response to exercise predicts future development of hypertension in young athletes, Eur Heart J source
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 16
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regular engagement in exercise training is associated with a lower risk of adverse cardiovascular events.

    “Regular engagement in exercise training is associated with a lower risk of adverse cardiovascular events.1”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Arem, 2015, Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship, JAMA Intern Med source

  • May combine two claims.

    Premisecitation

    Male masters endurance athletes with seemingly low cardiovascular disease risk have shown an increased prevalence of high coronary artery calcium scores and a greater number of coronary plaques compared with relatively sedentary counterparts of similar age.

    “However, male masters endurance athletes with seemingly low cardiovascular disease risk have shown an increased prevalence of high coronary artery calcium (CAC) scores and a greater number of coronary plaques compared with relatively sedentary counterparts of similar age.2–5”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [2] source

      The Results (p. 13) report higher CAC scores and CAC-score categories, and a higher prevalence of coronary plaque, in the most active men. But the comparison group was not sedentary: the Accelerated Coronary Artery Calcification section (p. 15) says even the least active athletes averaged roughly one hour of running per week. The paper reports plaque prevalence, not a greater number of plaques per athlete. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [3] source

      The Results and Study limitations sections (page unavailable) describe patients referred for suspected coronary artery disease, not masters endurance athletes. Searches for athletes, exercise, and sedentary comparators found no comparison of CAC scores or plaque counts between athletes and age-matched sedentary people. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [4] source
    • cites [5] Claessen, 2025, Coronary atherosclerosis in athletes: emerging concepts and preventive strategies, Eur Heart J source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques, compared with fit and healthy individuals with a similarly low cardiovascular risk profile.

    “recent findings report that lifelong endurance athletes had more coronary plaques, including more non-calcified plaques, compared with fit and healthy individuals with a similarly low cardiovascular risk profile.23”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] De Bosscher, 2023, Lifelong endurance exercise and its relation with coronary atherosclerosis, Eur Heart J source

  • May combine two claims.

    Premisecitation

    Hypertension is predictive of the presence of CAC in the general population and athletic individuals.

    “and is predictive of the presence of CAC in the general population25 and athletic individuals.11”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [25] source
    • cites [11] Berge, 2025, Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study, Eur Heart J Cardiovasc Imaging source

      For the athletic-individuals portion attributed to this paper, the Discussion reports that systolic blood pressure predicted CAC scores in middle-aged and older male athletes. It does not establish that a hypertension diagnosis predicts the presence of any CAC: hypertension’s role is described as possible, and the reported prediction concerns CAC scores rather than CAC presence. The general-population portion is attached to a different citation. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The study was powered based on an assumed prevalence of significant coronary artery calcium ≥100 Agatston units of approximately 18.8% in this population.

    “This prospective observational study was powered based on the assumption that the prevalence of significant CAC ≥100 AU in this population is approximately 18.8%.2 4”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [2] source

      The Cardiac Computed Tomography section (p. 10) categorizes CAC scores using a >100 Agatston-unit threshold, but does not give an assumed prevalence. The Data analysis section (pp. 10–11) and Results (p. 12) do not report an 18.8% assumption or a power calculation. Searches for “18.8” and sample-size or power assumptions found no supporting passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [4] source

  • May combine two claims.

    Premisecitation

    Calcified plaques are considered more stable and less prone to rupture compared with mixed or non-calcified plaques, which are associated with a higher risk of adverse cardiovascular events.

    “as calcified plaques are considered more stable and less prone to rupture compared with mixed or non-calcified plaques, which are associated with a higher risk of adverse cardiovascular events.21 22”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [21] source
    • cites [22] source

      The Methods and Results identify low-attenuation non-calcified plaque as a high-risk feature, and the Discussion links high-risk features to acute coronary syndromes and future cardiovascular events (page unavailable). But the paper does not establish that calcified plaques generally are more stable or less prone to rupture than mixed or non-calcified plaques; it also identifies spotty calcium as a high-risk feature. It does not assess mixed plaques as a category. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [28] Kim, 2020, Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners, Medicine (Baltimore) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Our existing experience of masters female athletes indicates a low prevalence of coronary atherosclerosis with a more favourable profile compared with healthy non-athletes of similar age.

    “Our existing experience of masters female athletes indicates a low prevalence of coronary atherosclerosis with a more favourable profile compared with healthy non-athletes of similar age.34”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] Papatheodorou, 2024, Prevalence of Coronary Atherosclerosis in Female Masters Endurance Athletes, Circulation source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Athletes with plaque were more likely to have calcified plaque, while non-athletes tended to have mixed plaques more frequently.

    “Two studies reported that athletes with plaque were more likely to have calcified plaque, while non-athletes tended to have mixed plaques more frequently.2 4”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] source

      The Results (pp. 13–14) report that, among participants with plaque, the most active group had fewer mixed plaques and more often had only calcified plaques than the least active group. The comparison was between exercise-volume groups within the study, not between athletes and non-athletes; the claim's description of the comparison group as non-athletes is unsupported. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [4] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Aerobic exercise training reduces systolic and diastolic BP by 4.5 mm Hg and 2.5 mm Hg, respectively.

    “Although aerobic exercise training reduces systolic and diastolic BP by 4.5 mm Hg and 2.5 mm Hg, respectively,26”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Large data from other studies have reported a lack of association between reported physical activity, CAC, and adverse coronary events in exercising females, including endurance athletes.

    “Large data from other studies have also reported a lack of association between reported physical activity, CAC, and adverse coronary events in exercising females, including endurance athletes.6 35”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Berry, 2025, High-Volume Physical Activity and Clinical Coronary Artery Disease Outcomes: Findings From the Cooper Center Longitudinal Study, Circulation source
    • cites [35] source

      The Discussion reports that, in a large sample of women, fitness was not associated with CAC after adjustment for cardiovascular risk factors. But the study measured treadmill-assessed fitness rather than reported physical activity, did not establish a finding for female endurance athletes, and explicitly states that it had no coronary outcomes data (Discussion). (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    In male masters endurance athletes with a low Framingham risk score and no clinical diagnosis of hypertension, 78 of 198 (39%) were hypertensive on 24-hour ambulatory blood pressure monitoring.

    “Seventy-eight (39%) athletes were hypertensive on ABP monitoring”
    • Also stated in: § Clinic and ambulatory blood pressure profile · plain
      “In total, 78 (39%) participants were hypertensive on ABP monitoring.14”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two athletes (1%) had non-calcified plaque.

    “Sixty-two athletes (31%) had calcified plaque, 32 (16%) had mixed plaque, 2 (1%) had non-calcified plaque and 26 (13%) had markers of high-risk plaque.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The association between the combined phenotype and high-risk plaque was directionally consistent but did not reach statistical significance.

    “The association with high-risk plaque was directionally consistent but did not reach statistical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Both ambulatory and exercise-induced hypertension are associated with a higher prevalence of atherosclerotic coronary artery disease in male endurance athletes.

    “Both ambulatory and exercise-induced hypertension are associated with a higher prevalence of atherosclerotic coronary artery disease in male endurance athletes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Elevated coronary artery calcium, significant stenoses, and high-risk morphology plaques are strongly associated with increased risk for major adverse coronary events.

    “Elevated CAC, significant stenoses, and high-risk morphology plaques are strongly associated with increased risk for major adverse coronary events.6”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Berry, 2025, High-Volume Physical Activity and Clinical Coronary Artery Disease Outcomes: Findings From the Cooper Center Longitudinal Study, Circulation source

  • May combine two claims.

    Interpretationown data

    Both ambulatory and exercise-induced hypertension are independently associated with adverse coronary plaque phenotypes, including higher coronary artery calcium burden, luminal stenosis and high-risk plaque morphology.

    “Both ambulatory and exercise-induced hypertension are independently associated with adverse coronary plaque phenotypes, including higher CAC burden, luminal stenosis and high-risk plaque morphology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Masters male endurance athletes have a high prevalence of occult hypertension, which is associated with high-risk features of coronary atherosclerosis.

    “Masters male endurance athletes have a high prevalence of occult hypertension, which is associated with high-risk features of coronary atherosclerosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hypertension is recognised as a primary preventable cause of CAD worldwide.

    “Hypertension is recognised as a primary preventable cause of CAD worldwide14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis adjusted a priori for age, lifetime exercise dose and resting clinic blood pressure.

    “We decided a priori to adjust for the following confounding factors: age, lifetime exercise dose and resting clinic BP.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The final target sample size was set at 220 participants to allow for up to 10% missing data.

    “To allow for up to 10% missing data, the final target sample size was set at 220 participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study did not assess the systolic blood pressure-workload slope across exercise stages.

    “we did not assess the systolic blood pressure–workload slope across exercise stages”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study only examined men.

    “this study only examined men”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regular moderate-intensity exercise reduces mortality by 15%.

    “and regular moderate-intensity exercise has been shown to reduce mortality by 15%,27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] source

  • May combine two claims.

    Premisecitation

    Male masters athletes exhibit higher CAC scores and greater prevalence of coronary atherosclerosis on CCTA compared with age and atherosclerotic risk-matched controls.

    “growing evidence suggests that male masters athletes exhibit higher CAC scores and greater prevalence of coronary atherosclerosis on CCTA compared with age and atherosclerotic risk-matched controls.4 20”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] source
    • cites [20] source

  • May combine two claims.

    Study design and conductnone given

    The study did not explore or account for the role of diet, alcohol consumption, substance use, lipoprotein(a), inflammatory biomarkers or polygenic risk for CAD.

    “This study did not explore or account for the role of diet, alcohol consumption, substance use, lipoprotein(a), inflammatory biomarkers or polygenic risk for CAD”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Hypertension is the leading modifiable risk factor for cardiovascular disease, playing a central role in the development and progression of coronary artery disease in the general population.

    “Hypertension is the leading modifiable risk factor for cardiovascular disease, playing a central role in the development and progression of CAD in the general population.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Caution is needed in applying this data to other ethnic groups because most athletes were Caucasian and previous data suggests variations in CAC scores among ethnic groups.

    “Thirdly, most athletes were of Caucasian ethnicity, and previous data suggests variations in CAC scores among ethnic groups, again necessitating caution in applying this data in the context of other ethnic groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Peak systolic BP during exercise was indexed to achieved workload and did not differ between groups.

    “although peak systolic BP during exercise was indexed to achieved workload and did not differ between groups”
    Quote in the paperSubstantial claim
29 of 29

  • The paper relies on this without support.

    The relationship between hypertension and coronary artery disease has not been previously explored in lifelong athletes with a seemingly low Framingham risk score.

    “The relationship between hypertension and CAD has not been previously explored in lifelong athletes with a seemingly low Framingham risk score.”

  • The paper relies on this without support.

    Hypertension causally contributes to coronary atherosclerosis in male masters endurance athletes.

    “may be contributing to coronary atherosclerosis”

  • The paper relies on this without support.

    High-risk plaque features (spotty calcification, positive remodelling) predict adverse cardiovascular events.

    “high-risk plaque markers spotty calcification and positive remodelling”

  • The paper relies on this without support.

    A CAC score ≥100 AU is a clinically meaningful threshold for increased coronary risk.

    “CAC score ≥100 AU”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Incorrect LMS percentage among hypertensive exercise responders

    Minor

    Four of the 93 hypertensive exercise responders is 4.3%, not the reported 3.2%.

    Reported 3.2 · recomputed 4.301075

  • Reported occult-hypertension prevalence includes athletes with abnormal clinic BP

    Minor

    The discussion calls 39% of the cohort occult hypertensive, but the results say only 70 of the 78 athletes with ambulatory hypertension had normal clinic BP. Those 70 represent about 35% of the 198-athlete cohort; 39% is the prevalence of ambulatory hypertension regardless of clinic BP.

  • Two-vessel disease totals differ between table partitions

    Minor

    Table 2 partitions the same cohort by ambulatory hypertension and by exercise BP response. Its two-vessel disease counts total 20 in the first partition (8 + 12) but 22 in the second (12 + 10).

  • CAC categories exceed the reported number with any CAC

    Minor

    The three nonzero CAC categories contain 141 athletes in total (94 + 32 + 15), but table 2 reports only 94 athletes with a CAC score greater than zero.

  • Incorrect LCx percentage among hypertensive exercise responders

    Minor

    Seventeen of the 93 hypertensive exercise responders is 18.3%, not the reported 14.0%.

    Reported 14 · recomputed 18.27957

  • Incorrect RCA percentage among hypertensive exercise responders

    Minor

    Eighteen of the 93 hypertensive exercise responders is 19.4%, not the reported 17.2%.

    Reported 17.2 · recomputed 19.354839

6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Sue DY , Stringer WW , Whipp BJ . Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications 6 ed. Philadelphia, PA: Wolters Kluwer, 2019.

Authors
O’Driscoll, J., Parry-Williams, G., Moser, J., Vlahos, I., Obaid, D., Basu, J., Finocchiaro, G., Fyyaz, S., MacLachlan, H., Marwaha, S., Miles, C., Papatheodorou, E., Gaibazzi, N., Tuttolomondo, D., Dey, D., Moreira, M., Bakalakos, A., Eijsvogels, T., Aengevaeren, V., Malhotra, A., Tome-Esteban, M., Sharma, R., Papadakis, M., & Sharma, S.
Affiliations
  • University of Leicester (GB)
  • Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK
  • St George’s University Hospitals NHS Foundation Trust (GB)
  • The University of Texas MD Anderson Cancer Center (US)
  • Swansea University (GB)
  • St George's, University of London (GB)
  • Cardiologia Centro, Azienda Ospedaliero-Universitaria di Parma, Parma, Emilia-Romagna, Italy
  • Cedars-Sinai Medical Center (US)
  • City St George's, University of London (GB)
  • Radboud University Nijmegen (NL)
  • Radboud University Medical Center (NL)
  • Manchester Metropolitan University (GB)
Corresponding author
Sharma, Sanjay
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2026-04-24
Volume
60
Issue
16
Pages
1227-1237
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2025-111347
PMC
PMC13479618
OpenAlex
W7155542737
Semantic Scholar
276e4836ca62e7e900732a027c8105eda83cc919
Cited by
0
References
33
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Sports Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research (NIHR) Leicester BRC (NIHR203327)
  • British Heart Foundation
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
exercise-induced hypertension, coronary artery disease, coronary artery calcification, coronary artery stenosis, vulnerable plaque, ambulatory blood pressure monitoring, male athletes, cardiovascular risk
MeSH terms
Computed Tomography Angiography, Coronary Artery Disease, Humans, Hypertension, Male, Middle Aged, Physical Endurance, Rest, Risk Factors, Exercise, Blood Pressure Monitoring, Ambulatory, Athletes, Plaque, Atherosclerotic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-12.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-12.

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