Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension : A Scientific Statement from the American Heart Association and the American College of Cardiology

Key Words

  • ACC/AHA Scientific Statements
  • athletes
  • blood pressure measurement;
  • cardiovascular abnormalities
  • hypertension

An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athletics. The 2013 update from the American Heart Association using the National Health and Nutrition Examination (NHANES) data from 2007 to 2010 estimates that 9.1% of men aged 20 to 34 years and 6.7% of women of that age are hypertensive, based on having an elevated BP measurement or answering “yes” to the question, “Are you taking antihypertensive medication or were you told that you had hypertension?” (1)The prevalence in children and adolescents is estimated to be ≈3.5%, with higher percentages in older and obese children (2). The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week (3). However, BP measurements in the competitive athlete are typically obtained by different healthcare providers, which makes it particularly necessary that the testing conditions be standardized before the diagnosis of hypertension is made. People >18 years of age with a BP >140 mm Hg systolic and/or>90 mm Hg diastolic are considered to have hypertension (3). In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves open to question when an adult age criterion for hypertension should be applied to the adolescent (4). In determining the level of competitive athletic activity that a hypertensive person may engage in, it is also important to determine the degree of hypertension-related target-organ damage. Although hypertension has been associated with an increased risk for complex ventricular arrhythmias and sudden death, this cardiovascular risk factor per se has not been implicated in sudden death in young competitive athletes (5). For the general population, increased levels of noncompetitive recreational physical activity are generally regarded as beneficial. With physical activity, BP typically falls, the incidence of hypertension drops 6 and 7, and protection against stroke is afforded (8). Those who are hypertensive derive protection from both all-cause and cardiovascular mortality by maintaining higher levels of cardiorespiratory fitness (9).

 


Autor / Fonte:Henry R Black, Domenic Sica, Keith Ferdinand, William B White Journal of the American College of Cardiology 2015 October 27
Link: http://www.sciencedirect.com/science/article/pii/S0735109715065742/pdfft?md5=05dc6d4803244225d0977c3404181348&pid=1-s2.0-S0735109715065742-main.pdf