Table III.

 Recommendations of the 36th Bethesda Conference for Hypertension in Athletes

Before individuals commence training for competitive athletics, they should undergo careful assessment of blood pressure (BP), and those with initially high levels (>140/90 mm Hg) should have out‐of‐office measurements to exclude isolated office white coat hypertension. Those with prehypertension (120/80 mm Hg–139/89 mm Hg) should be encouraged to modify lifestyle but should not be restricted from physical activity. Those with sustained hypertension should have echocardiography. Left ventricular hypertrophy (LVH) beyond that seen with “athletes’ heart” should limit participation until BP is normalized by appropriate drug therapy.

The presence of stage 1 hypertension in the absence of target organ damage including LVH or concomitant heart disease should not limit the eligibility for any competitive sport. Once having begun a training program, the hypertensive athlete should have BP remeasured every 2–4 months (or more frequently, if indicated) to monitor the impact of exercise.

Athletes with more severe hypertension (stage 2), even without evidence of target organ damage such as LVH, should be restricted, particularly from high static sports (classes IIIA–IIIC), until their hypertension is controlled by either lifestyle modification or drug therapy.

All drugs being taken must be registered with appropriate governing bodies to obtain a therapeutic exemption.

When hypertension coexists with another cardiovascular disease, eligibility for participation in competitive athletics is usually based on the type and severity of the associated condition.

Reprinted with permission from Kaplan et al. ²⁷