The following are key perspectives from the European Position Statement on Recommendations for Participation in Competitive Sports of Athletes With Arterial Hypertension:

1. Evaluation of the athlete with hypertension should include a history, physical examination, electrocardiogram (ECG), and echocardiogram (for left ventricular [LV] hypertrophy), and exercise testing (for blood pressure [BP] response during exercise).
2. Hypertension should be assessed in the context of other cardiovascular risk factors (men >55 or women >65 years, diabetes, smoking, dyslipidemia, abdominal obesity, family history of premature cardiovascular disease) and evidence of target organ damage (LV hypertrophy, diastolic dysfunction, increased creatinine, microalbuminuria).
3. Supplements, energy drinks, anti-inflammatory drugs, thyroid hormone (for weight reduction), and performance-enhancing substances (erythropoietin, anabolic steroids) should be considered as possible causes of secondary hypertension in the athlete.
4. Athletes with hypertension should be treated according to general guidelines, including the use of nonpharmacological measures as initial steps: salt restriction, weight reduction in the setting of obesity, alcohol restriction, smoking cessation, increased consumption of fruits and vegetables, and the discontinuation of supplements and ergogenic and anti-inflammatory medications.
5. The use of antihypertensive pharmacotherapy among athletes should include consideration of substances prohibited in competitive sports. For example, diuretics are banned at all times in all sports because they can mask the use of performance-enhancing drugs, and beta-adrenergic antagonists are prohibited in some sports including archery and shooting.
6. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are a preferred choice for medications to treat hypertension among athletes because they do not affect performance and are not banned medications. Alternatively or additionally, calcium channel blockers may be considered. Beta-blockers are rarely used because of common resting bradycardia or atrioventricular block in athletes, a potential negative impact on aerobic exercise performance, and prohibition in some sports.
7. An athlete with hypertension and low or moderate cardiovascular risk (10-year risk of cardiovascular mortality ≤4%) should be able to participate in all sports without restrictions if BP is well controlled. Temporary restriction from competitive sports is recommended for most athletes if BP is not yet controlled.
8. An athlete with hypertension and high or very high cardiovascular risk (10-year risk of cardiovascular mortality ≥5%) should be able to participate in all competitive sports with the exception of power disciplines (including weight lifting, wrestling, sprinting, shot put and discus/javelin, bobsled, and alpine and water skiing) if BP is well controlled. Temporary restriction from competitive sports is recommended for most athletes if BP is not yet controlled.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Implantable Devices, EP Basic Science, Exercise, Hypertension, Smoking

Keywords: Adrenergic Antagonists, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Athletes, Atrioventricular Block, Blood Pressure, Bradycardia, Calcium Channel Blockers, Creatinine, Diabetes Mellitus, Diuretics, Dyslipidemias, Electrocardiography, Erythropoietin, Exercise, Hypertension, Hypertrophy, Obesity, Obesity, Abdominal, Performance-Enhancing Substances, Primary Prevention, Smoking, Smoking Cessation, Testosterone Congeners, Thyroid Hormones, Weight Lifting, Weight Loss, Sports

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