Prevalence of arterial (pre-)hypertension and white coat hypertension in competitive athletes according to the classification of the ESC vs. JNC guidelines of arterial hypertension

Background

Arterial hypertension (aHT) is the most common risk factor for cardiovascular disease in competitive sports. The exact prevalence of aHT and prehypertension (preHT) in the cohort of high-performance athletes is unclear due to an often insufficiently standardized measurement methodology and different threshold definitions (ESC vs. JNC). Furthermore, the prevalence of white coat hypertension is unknown.
Methods

Retrospective analysis (n=302, f=39%; 19.8±4.9 years old) of sports medical examinations at one of the Olympic Training Centres in Germany. Detailed information of the athletes’ population can be found in Table 1. Arterial blood pressure values obtained by standardized blood pressure measurement were analysed at 4 different times: At rest (RR1), in the resting phase before the start of bicycle ergometry (RR2), at 100 watts (RR3) and at maximum exertion (RR4). The classification into the categories normotensive, prehypertensive and hypertensive was based on the respective definitions of the ESC and JNC.
Results

The prevalence of aHT in RR1 was high and differed significantly depending on the guideline definition (32%ESC vs. 69%JNC, p<0.001). The further course showed, however, that in the majority of cases aHT could no longer be confirmed in RR2 (20/95ESC and 84/208JNC with aHT in RR2). The observed white coat hypertension was significantly more common in male athletes (m=45.2%ESC vs. f=27.2%ESC, p<0.001). During the exercise test (RR3), only 10 athletes (6%) were still abnormal (≥ 180mmHg systolic). The measured values of preHT were similar (RR1: 29.1% ESC vs. 18.5% JNC; preHT not confirmed in RR2 at: 67/88ESC vs. 41/56JNC). White coat hypertension was present here regardless of gender (m=62.5%ESC vs. f=59.4%ESC). Further results and the relation to the different sports can be seen in Fig. 1.
Conclusion
The prevalence of aHT varied considerably, depending on the respective guideline classification, measurement setting and gender. In competitive athletes the office measurement (RR1) frequently led to false-positive elevated BP values. By changing the measurement setting (RR2), the prevalence of aHT decreased significantly indicating a high number of white coat hypertension in RR1. These results reflect the current diverse study situation on the prevalence of aHT and illustrate the difficulty to make a generally valid statement on this basis. A standardized measurement methodology as well as the consideration of gender and the different guideline classifications are necessary to define the prevalence of aHT in the cohort of athletes. Further studies are requested.