Hypertension control is needed in elderly marathon runners!

Abstract

The performance of sporting activities like cycling and running is a life style factor that improves health and increases the duration of healthy life [1, 2]. Heavy exercise, such as rowing, cycling, and marathon running at competitive levels, is considered to be healthy, although evidence of the opposite is published from time to time [3, 4]. It is known for quite some time that the hearts of extensive sport athletes develop left ventricular hypertrophy (LVH), known under the name of the ''athlete's heart''. This type of LVH is considered physiological [5][6][7][8][9][10]. Conditions like hypertensive heart disease lead to pathological LVH [11][12][13][14][15], as it is often associated with perivascular and interstitial fibrosis of left ventricular myocardium [16], diastolic heart failure [17,18], arrhythmias [19,20] and mortality [21].Previous studies from our institution have already addressed the issue of physiological versus pathological LVH [5,22,23]. First of all we studied the accuracy of M-mode echocardiography and two different twodimensional echocardiographic approaches in the assessment of left ventricular mass and volumes in endurance-trained and strength-trained athletes, using cardiovascular magnetic resonance (CMR) imaging as reference standard [23]. It was shown that in general practice the two-dimensional echocardiographic approach was the most accurate estimator of left ventricular mass and volumes in both controls and athletes. For research purposes, however, CMR remains the most accurate and reliable method to assess cardiac anatomy and function [24][25][26][27]. In a next study we addressed the question of whether training-induced left ventricular hypertrophy in athletes is a physiological rather than a pathophysiological phenomenon [28]. To that purpose we studied 21 elite cyclists and 12 healthy control subjects. Left ventricular mass, volume, and function were determined by CMR and myocardial high-energy phosphates were examined by 31P magnetic resonance spectroscopy. It was shown that LVH in cyclists was not associated with significant abnormalities of cardiac function or metabolism as assessed by CMR and spectroscopy. These observations suggested that training-induced left ventricular hypertrophy in cyclists is predominantly a physiological phenomenon. Finally in a meta-analysis paper, involving 59 studies and 1,451 athletes, i.e., endurance-trained athletes (long-distance runners), strength-trained athletes (weight lifters, power lifters, bodybuilders, wrestlers, and throwers), and athletes involved in combined forms of dynamic and static training (cyclists and rowers), we confirmed the hypothesis of divergent cardiac adaptations in dynamic and static sports [5]. Overall, the athlete's heart demonstrated normal systolic and diastolic cardiac functions. However, our meta-analysis concerned relatively young athletes between 18 and 40 years.