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Athletes with Systemic HypertensionRobert H. Fagard, MD, PhDHypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, University of Leuven,KU Leuven, U.Z. Gasthuisberg – Hypertensie, Herestraat 49, B-3000 Leuven, BelgiumEpidemiologyBlood pressure increases with age. Systolicblood pressure continues to increase throughoutadult life, related to progressive arterial stif f ening,whereas diastolic blood pressure plateaus in thesixth decade of life and decreases thereafter [1].Blood pressure is lower in women than in menbelow the age of about 50, rises more steeply inwomen around menopause, and becomes higherin women than in men thereafter.In recent epidemiologic studies, hypertension isdef i ned as systolic blood pressure greater than orequal to 140 mm Hg or diastolic blood pressuregreater than or equal to 90 mm Hg, or being onantihypertensive treatment. The prevalence ofhypertension in the population amounts to about25% and is expected to increase to up to about29% in 2025 [2].When broken down by age and gender, theprevalence is approximately 15%, 30%, and 55%in men aged 18 to 39, 40 to 59, and 60 and older,respectively, and about 5%, 30%, and 65% inwomen in these age groups. The prevalence ofisolated systolic hypertension is very low beforethe age of 50, but increases sharply thereafter.These epidemiologic data indicate that hyperten-sion may already be present in the young athlete,although rarely, but occurs more frequently in theolder sportsman.Unless blood pressure is measured, hyperten-sion may remain undetected because it usuallycauses no symptoms. However, about 25% ofpatients who have hypertension by conventionalmeasurements have a normal blood pressure on24-hour ambulatory monitoring or on homeblood pressure measurements; this phenomenonis the so-called ‘‘white-coat’’ or isolated clinichypertension [3,4]. Young athletes with clinichypertension often have normal blood pressureon ambulatory monitoring [5]. On the otherhand, patients may have masked or isolated am-bulatory hypertension, which is characterized bya normal blood pressure in the of f i ce and anelevated blood pressure out of the of f i ce [6].Hypertension as a cardiovascular risk factorHypertension is associated with an increasedincidence of all-cause and cardiovascular mortal-ity, sudden death, stroke, coronary heart disease,heart failure, atrial f i brillation, peripheral arterialdisease, and renal insuf f i ciency. In the populationat large, the relationship between cardiovascularcomplications and blood pressure is linear [7]. Theprognosis of white-coat hypertension is betterthan that of sustained ambulatory hypertension,and studies suggest that it is even similar to thatof persons with true normal blood pressure,whereas patients who have masked hypertensionappear to have a worse outcome than true normo-tensives [3,4,6,8–10].Despite conclusive evidence that antihyperten-sive therapy reduces the complications of hyper-tension [1,11], only about one half of all patientswho have hypertension are under treatment andonly a fraction of these have normal blood pres-sure [12,13]. Systolic blood pressure appears tobe more dif f i cult to control than diastolic bloodpressure, particularly in older patients.Classif i cation of hypertensionThe classif i cation of hypertension is based onmultiple conventional blood pressure measure-ments taken on separate occasions, in the sitting E-mail address: robert.fagard@uz.kuleuven.ac.be0733-8651/07/$ - see front matter ? 2007 Elsevier Inc. All rights reserved.doi:10.1016/j.ccl.2007.07.001 cardiology.theclinics.comCardiol Clin 25 (2007) 441–448