Masked hypertension and cardiac remodeling in middle-aged endurance athletes

Abstract

Objectives: Extensive endurance training and arterial hypertension are established risk factors for atrial fibrillation. We aimed to assess the proportion of masked hypertension in endurance athletes and the impact on cardiac remodeling, mechanics, and supraventricular tachycardias (SVT).Methods: Male participants of a 10-mile race were recruited and included if office blood pressure was normal (<140/90 mmHg). Athletes were stratified into a masked hypertension and normotension group by ambulatory blood pressure. Primary endpoint was diastolic function, expressed as peak early diastolic mitral annulus velocity (E'). Left ventricular global strain, left ventricular mass/ volume ratio, left atrial volume index, signal-averaged Pwave duration (SAPWD), and SVT during 24-h Holter monitoring were recorded.Results: From 108 runners recruited, 87 were included in the final analysis. Thirty-three (38%) had masked hypertension. The mean age was 42 AE 8 years. Groups did not differ with respect to age, body composition, cumulative training hours, and 10-mile race time. Athletes with masked hypertension had a lower E' and a higher left ventricular mass/volume ratio. Left ventricular global strain, left atrial volume index, SAPWD, and SVT showed no significant differences between the groups. In multiple linear regression analysis, masked hypertension was independently associated with E' (beta ¼ -0.270, P ¼ 0.004) and left ventricular mass/volume ratio (beta ¼ 0.206, P ¼ 0.049). Cumulative training hours was the only independent predictor for left atrial volume index (beta ¼ 0.474, P < 0.001) and SAPWD (beta ¼ 0.481, P < 0.001). Conclusion:In our study, a relevant proportion of middleaged athletes had masked hypertension, associated with a lower diastolic function and a higher left ventricular mass/ volume ratio, but unrelated to left ventricular systolic function, atrial remodeling, or SVT.

Cardiac remodeling after six weeks of high-intensity interval training to exhaustion in endurance-trained males

“…Few studies have evaluated the impact of HIIT on BP measured by ambulatory BP monitoring, a measurement that is more specific for systemic arterial hypertension diagnosis Santos et al, 2016;Whelton et al, 2018). Our results represent clinically positive findings for endurance-trained participants since systemic arterial hypertension is the most common cardiovascular disease in these individuals (Leddy & Izzo, 2009) and it is often masked (Trachsel et al, 2015). In our study, our three participants that were considered mildly hypertensive at baseline normalized their ambulatory BP after HIIT.…”

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

“…71 Other studies have proposed that exercise-induced hypertension could underlie the instauration of maladaptive atrial processes in some athletes, 18,72 but current evidence does not support this notion. 73 Haemodynamic overload during strenuous exercise training might trigger mechanisms involved in myocardial fibrosis formation. Intense exercise increases atrial wall stretch.…”

Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs

“…This is emphasised by the findings of the Swedish Lidingö-loppet, a 30 km cross-country race, showing that athletes have increased the running times during the years 1993–2007, which is a possible marker of decreased fitness, as well as that of being progressively older 62. Furthermore, masked hypertension ‘unmasked’ by ambulatory BP recordings was common among 33% of middle-aged Swiss runners 63. These findings emphasise the importance of including BP measurements in the cardiac screening of competitive athletes, as advocated by the European Association of Cardiac Prevention and Rehabilitation (EACPR) 64…”