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Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling
Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA.ORCID iD: 0000-0002-3751-7180
Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA .
Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Stanford University, Stanford Sports Cardiology, Stanford, California, USA.
Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA / Department of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA .
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2019 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, no 16, p. 1223-1230Article in journal (Refereed) Published
Abstract [en]

Objectives To explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.Methods In this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if >=140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.Results In cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p<0.001), body mass index (BMI) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.Conclusion In a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019. Vol. 105, no 16, p. 1223-1230
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Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:liu:diva-159932DOI: 10.1136/heartjnl-2019-314815OAI: oai:DiVA.org:liu-159932DiVA, id: diva2:1346669
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-08-28Bibliographically approved

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