The Young Athlete with High Blood Pressure

Introduction

Sooner or later, you may be challenged with the opportunity to participate in the care of a young athlete with high blood pressure readings, whom you see because a medical evaluation is necessary for him or her to participate in a sports program. For example, a 19-year-old, healthy-appearing guy is sent to you because his blood pressure is 160/94 mm Hg, and the basketball team coach was concerned enough to have him checked out. Your input is requested. Assuming you find no reason from your evaluation to suspect or pursue a secondary cause for elevated blood pressure, and assuming you confirm the increased blood pressure readings, you are faced with these issues: 1) Do you treat the elevated blood pressure, and 2) Do you allow the young man to play sports, especially sports involving an intense degree of effort?

In the absence of end-organ damage, high blood pressure is not a barrier to sports participation, even if the individual is on drug therapy.^[1,2]

In young athletes, the point is frequently made that they are often bigger than their peers. Consequently, their blood pressures need to be placed in the perspective of their height and weight. In our example, however, these blood pressure levels qualify as hypertensive, even for Goliath. In young endurance athletes, the electrocardiogram may show several abnormalities,^[3] such as an increase in QRS voltage, that can make it difficult to convince oneself that there is no hypertensive cardiac involvement. In some cases, an echocardiogram with a Doppler evaluation of diastolic function can help in evaluating young athletes with abnormal electrocardiograms for structural heart disease.

Would you treat this young athlete with drug therapy, and, if so, with what agent(s)? Acknowledging that sometimes blood pressure will, on occasion, spontaneously improve in younger patients, you cannot know with certainty what will happen. Without this assurance, our approach has been to treat them.

Some young people with blood pressures like this have an elevated cardiac output, and a ß blocker would be a reasonable choice to use.

The dosage should be kept as low as possible, and it should be recognized that their heart rate is often already slow, and that ß blockers may reduce exercise tolerance and impair heat dissipation during exercise.^[1] Alternatively, a diuretic could be used in a small dose, alone, or added (if necessary) to a ß blocker or other agent^[1] -- for example, 12.5 mg of hydrochlorothiazide and/or 25 mg of atenolol. The use of an angiotensin-converting enzyme inhibitor or a calcium channel blocker are other options that have some attractiveness because they are less likely to decrease maximal exercise capacity, maximal oxygen use during exercise, or maximal heart rate.^[4]

It is important to know in what arena a young hypertensive athlete will be competing, since some agents are prohibited and it can affect the choice of medication (or his or her participation). For example, diuretics and ß blockers, although reasonable choices, have been prohibited by some athletic governing bodies.^[2] Clearly, then, alternatives need to be chosen for these patients, and some investigative work may be necessary to find out what is, or is not, allowed.

Many coaches are willing and able to measure blood pressure. Their involvement can promote compliance and provide feedback on how well therapy is tolerated, especially in terms of athletic performance.

In our experience, blood pressure can be controlled with medication, without exercise-limiting side effects. Occasionally, therapy can be discontinued after blood pressure has been controlled for a year or more.

© 2000 Le Jacq Communications, Inc.

Cite this: The Young Athlete with High Blood Pressure - Medscape - Nov 01, 2000.