TY - JOUR
T1 - Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes
AU - O’Driscoll, Jamie
AU - Parry-Williams, Gemma
AU - Moser, Joanna
AU - Vlahos, Ioannis
AU - Obaid, Daniel
AU - Basu, Joyee
AU - Finocchiaro, Gherardo
AU - Fyyaz, Saad
AU - MacLachlan, Hamish
AU - Marwaha, Sarandeep
AU - Miles, Chris
AU - Papatheodorou, Efstathios
AU - Gaibazzi, Nicola
AU - Tuttolomondo, Domenico
AU - Dey, Damini
AU - Moreira, Maximiliano
AU - Bakalakos, Athanasios
AU - Eijsvogels, Thijs
AU - Aengevaeren, Vincent
AU - Malhotra, Aneil
AU - Tome-Esteban, Maria
AU - Sharma, Rajan
AU - Papadakis, Michael
AU - Sharma, Sanjay
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2026
Y1 - 2026
N2 - Objective: Recent studies have demonstrated a greater prevalence of coronary atherosclerosis in male masters endurance athletes, but the underlying contributors remain unclear. We explored the relationship between occult resting and exercise-induced hypertension with coronary atherosclerosis characteristics. Methods: 198 male masters endurance athletes with a low Framingham risk score (<10%) and no clinical diagnosis of hypertension underwent 24-hour ambulatory blood pressure (ABP) monitoring and exercise BP assessment. Coronary CT angiography assessed coronary artery calcification (CAC) score, luminal stenosis and high-risk plaque features. Results: Seventy-eight (39%) athletes were hypertensive on ABP monitoring and 93 (47%) demonstrated a hypertensive response to exercise. A CAC score of 1–99 Agatston units (AU), 100–399 AU and ≥400 AU was present in 94 (47%), 32 (16%) and 15 (8%) athletes, respectively. Twenty-four (12%) athletes had coronary stenoses >50%. Sixty-two athletes (31%) had calcified plaque, 32 (16%) had mixed plaque, 2 (1%) had non-calcified plaque and 26 (13%) had markers of high-risk plaque. Hypertension on ABP monitoring was significantly associated with a CAC score ≥100 AU (OR: 2.56; 1.08 to 6.04) and coronary stenosis >50% (OR: 2.92; 1.17 to 7.33). A hypertensive response to exercise was significantly associated with coronary stenosis >50% (OR: 4.72; 1.65 to 13.5) and the presence of high-risk plaque (OR: 3.27; 1.27 to 8.43). Conclusion: Masters male endurance athletes have a high prevalence of occult hypertension, which is associated with high-risk features of coronary atherosclerosis. Both ambulatory and exercise-induced hypertension are associated with a higher prevalence of atherosclerotic coronary artery disease in male endurance athletes. Early identification and timely clinical management of this classic cardiovascular disease risk factor may reduce the burden of coronary atherosclerosis in athletes.
AB - Objective: Recent studies have demonstrated a greater prevalence of coronary atherosclerosis in male masters endurance athletes, but the underlying contributors remain unclear. We explored the relationship between occult resting and exercise-induced hypertension with coronary atherosclerosis characteristics. Methods: 198 male masters endurance athletes with a low Framingham risk score (<10%) and no clinical diagnosis of hypertension underwent 24-hour ambulatory blood pressure (ABP) monitoring and exercise BP assessment. Coronary CT angiography assessed coronary artery calcification (CAC) score, luminal stenosis and high-risk plaque features. Results: Seventy-eight (39%) athletes were hypertensive on ABP monitoring and 93 (47%) demonstrated a hypertensive response to exercise. A CAC score of 1–99 Agatston units (AU), 100–399 AU and ≥400 AU was present in 94 (47%), 32 (16%) and 15 (8%) athletes, respectively. Twenty-four (12%) athletes had coronary stenoses >50%. Sixty-two athletes (31%) had calcified plaque, 32 (16%) had mixed plaque, 2 (1%) had non-calcified plaque and 26 (13%) had markers of high-risk plaque. Hypertension on ABP monitoring was significantly associated with a CAC score ≥100 AU (OR: 2.56; 1.08 to 6.04) and coronary stenosis >50% (OR: 2.92; 1.17 to 7.33). A hypertensive response to exercise was significantly associated with coronary stenosis >50% (OR: 4.72; 1.65 to 13.5) and the presence of high-risk plaque (OR: 3.27; 1.27 to 8.43). Conclusion: Masters male endurance athletes have a high prevalence of occult hypertension, which is associated with high-risk features of coronary atherosclerosis. Both ambulatory and exercise-induced hypertension are associated with a higher prevalence of atherosclerotic coronary artery disease in male endurance athletes. Early identification and timely clinical management of this classic cardiovascular disease risk factor may reduce the burden of coronary atherosclerosis in athletes.
KW - Athletes
KW - Cardiology
KW - Exercise
UR - https://www.scopus.com/pages/publications/105039093827
UR - https://www.scopus.com/pages/publications/105039093827#tab=citedBy
U2 - 10.1136/bjsports-2025-111347
DO - 10.1136/bjsports-2025-111347
M3 - Article
C2 - 42031512
AN - SCOPUS:105039093827
SN - 0306-3674
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
ER -