Caselli Stefano, Vaquer Sequì Antonia, Lemme Erika, Quattrini Filippo, Milan Alberto, D'Ascenzi Flavio, Spataro Antonio, Pelliccia Antonio
Department of Cardiology, Institute of Sports Medicine and Science, Rome, Italy.
Department of Cardiology, Institute of Sports Medicine and Science, Rome, Italy.
Am J Cardiol. 2017 May 15;119(10):1616-1622. doi: 10.1016/j.amjcard.2017.02.011. Epub 2017 Mar 1.
The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values.
本研究的目的是评估一大群竞技运动员中系统性高血压的患病率、决定因素及临床管理情况：连续2040名运动员（年龄25±6岁，64%为男性）接受了临床评估，包括血液检查、心电图、运动试验、超声心动图及眼科评估。65名运动员（3%）被诊断为高血压（男性=57名；87%），其中5名有继发性病因（3名甲状腺功能障碍，1名肾动脉狭窄，1名药物所致）。与血压正常的运动员相比，高血压运动员左心室肥厚更明显，且更常表现为向心性模式。此外，他们的体能轻度下降，与血压正常的运动员相比，其心血管风险特征更高。多因素逻辑回归分析显示，家族高血压病史（比值比2.05；95%置信区间1.21至3.49；p=0.008）和体重指数（比值比1.32；95%置信区间1.23至1.40；p<0.001）是高血压最强的预测因素。治疗干预包括57名运动员成功进行了生活方式改变，3名原发性高血压患者需要额外药物治疗。继发性高血压根据潜在疾病进行治疗。平均随访18±6个月后，所有高血压运动员均实现并维持了血压的最佳控制，且运动参与不受限制。总之，运动员中高血压的患病率较低（3%），且很大程度上与家族病史和超重有关。在绝大多数高血压患者中，生活方式改变足以实现血压值的最佳控制。
