title: The impact of elevated blood pressure on exercise capacity in elite athletes.
abstract: OBJECTIVE
  Hypertension is one of the most prevalent cardiovascular disorders in athletes. The aims of our study were to assess the impact of elevated blood pressure (BP) on exercise capacity in athletes and evaluate the differences in left ventricular structure and function.
  
  
  METHODS
  Elite male athletes (n=517, aged 23±5years) underwent Doppler echocardiography with tissue Doppler imaging. Diastolic function was assessed by measuring peak early and late transmitral (E and A) and annular diastolic filling velocities (e' and a'). Maximal cardiopulmonary exercise testing was performed to measure maximal oxygen consumption (VO2max), ventilatory anaerobic threshold (VAT) and heart rate reserve (HRR). After BP measurement, they were grouped according to the ESH/ESC guidelines on: optimal (OBP), normal (NBP), high normal BP (HNBP), and hypertensive (HT).
  
  
  RESULTS
  We found significantly lower VO2max, VAT and HRR in the groups with HNBP and HT, after the adjustment for the type of sport, body fat content and age. There was an increasing trend in resting HR among groups (p<0.001). Although none of the subjects had impaired diastolic function, the HT group had higher left atrial volume, and lower e' and e'/a'. Resting systolic BP (p<0.05), HR (p<0.001), HRR (p<0.001) and e'/a' (p<0.01) independently predicted VO2max. Indexes E/e' and e'/a' were associated with resting systolic BP (p<0.05).
  
  
  CONCLUSIONS
  Even in the absence of structural or functional heart damage, elevated BP in elite athletes, together with the presence of autonomic dysfunction, leads to decrease in exercise capacity. Staging of hypertension according to the BP level, on the one hand, and reflexion of BP on cardiopulmonary capacity, on the other, may be coupled for further risk stratification.
authors.affiliation: Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia; Serbian Institute of Sport and Sports Medicine, Belgrade, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Mazic
authors.affiliation: University Clinical Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia. Electronic address: jsuzic@yahoo.com.
authors.forename: Jelena
authors.initials: J
authors.lastname: Suzic Lazic
authors.affiliation: University Clinical Center "Zvezdara", Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Dekleva
authors.affiliation: Serbian Institute of Sport and Sports Medicine, Belgrade, Serbia.
authors.forename: Milena
authors.initials: M
authors.lastname: Antic
authors.affiliation: School of Medicine, University of Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Soldatovic
authors.affiliation: Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Djelic
authors.affiliation: Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia.
authors.forename: Dejan
authors.initials: D
authors.lastname: Nesic
authors.affiliation: Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia.
authors.forename: Tijana
authors.initials: T
authors.lastname: Acimovic
authors.affiliation: Faculty of Sport and Physical Education, University of Novi Sad, Serbia.
authors.forename: Milivoje
authors.initials: M
authors.lastname: Lazic
authors.affiliation: University Clinical Center "Zemun", Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Lazovic
authors.affiliation: Institute of Medical Physiology, School of Medicine, University of Belgrade, Serbia.
authors.forename: Slavica
authors.initials: S
authors.lastname: Suzic
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D017079:Exercise Tolerance / Q000502:physiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D010101:Oxygen Consumption; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
keywords: Athletes; Diastolic function; Exercise capacity; Hypertension