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Bridget J. Quinn, MD |
Hypertension affects about five of every 100 children and is the most common cardiovascular disease in pediatric athletes. While exercise helps reduce the risk of hypertension in children and adolescents, strenuous exercise can cause spikes in blood pressure. If a child already has hypertension, the increase in blood pressure could lead to vascular complications, such as stroke.
In June, the American Academy of Pediatrics (AAP) issued new guidelines concerning young athletes with hypertension, based on recent research into pediatric blood pressure. The bottom line? It's appropriate for many athletes with hypertension to participate in sports—as long as they're adequately monitored and make training and lifestyle changes. Here, Bridget J. Quinn, MD, of Children's Hospital Boston's Sports Medicine Program, discusses the new recommendations.
Childhood hypertension is classified as blood pressure measurements greater than or equal to 95th percentile for age, gender and height, on three or more separate tests.
- Pre-hypertension is classified as those with blood pressures between the 90th and 95th percentile and is a systolic blood pressure of 120 to 139 and/or diastolic 80 to 89.
- Stage 1 is classified as those who range from the 95th to 99th percentile and is a systolic blood pressure of 140 to 159 and/or diastolic 90 to 99.
- Stage 2 is classified as those above the 99th percentile and is a systolic blood pressure of over 160 and/or diastolic over 100.
The new guidelines clarify when it's safe and not safe for athletes with high blood pressure to participate in sports. They incorporate the modified JNC 7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) adult hypertension classifications and new pediatric blood pressure data. There's a pre-hypertension category that places individuals at an increased risk and need for lifestyle changes and surveillance. The 99th percentile for high blood pressure helps the clinician determine the severity and need for temporary activity restriction.
The level of activity safe for young athletes with hypertension should be based on which category best defines them.
- Athletes with pre-hypertension are eligible for all competitive sports but should have their blood pressure checked every six months.
- Athletes with stage 1 hypertension, without signs of end-
organ damage such as an enlarged heart, are eligible for all competitive sports. Those with signs of end-organ damage should be referred to specialists. Blood pressure should be checked every six months, and lifestyle changes are recommended.
- Athletes with stage 2 hypertension without end-organ damage need to reduce their blood pressure to normal levels before participating in sports. If their blood pressure isn't controlled, they shouldn't play sports likely to cause sharp temporary spikes in blood pressure, like martial arts, and should be seen by a pediatric subspecialist.
- Athletes may have underlying cardiac disease in addition to their high blood pressure. In these cases, participation is based on the severity of the cardiovascular disease.
Athletes with pre-hypertension or high blood pressure should limit substances that can cause spikes in blood pressure—including over-the-counter medication containing stimulants, tobacco and caffeinated energy drinks.
Sodium balance also influences blood pressure but must be carefully regulated depending on salt loss through sweat and water intake during rehydration. These risks should be reviewed with all athletes and modified when possible.
Obesity can also be a concern in some sports, especially ones that value size and bulk, like football. Some kids may "beef up" for football season, but in doing so, they place themselves at risk for elevated blood pressure, diabetes and trouble sleeping.
The activity levels of kids with hypertension should be monitored more closely than players without high blood pressure, but it shouldn't restrict them to the sidelines. It's only really a concern for those with severely elevated blood pressure, and once the blood pressure is under control, those children should still get regular exercise to stay healthy.
It's important to have the child resting for at least five minutes before taking her blood pressure. An appropriate-sized cuff should be used, since one that's too small may result in an erroneously elevated blood pressure. The diagnosis is not established unless the blood pressure is elevated on three or more separate occasions. The athlete should undergo a thorough physical with appropriate laboratory testing. Treatment should focus on lifestyle modifications and a well-balanced diet. Drug therapy may be prescribed by a pediatric subspecialist. Use of stimulants, caffeine, tobacco and other medications should be reviewed and limited.
Athletes who have Stage 1 or Stage 2 hypertension may require a more extensive work-up, including an echocardiogram. Special populations include overweight children, who are at risk for sleep apnea that further increases the risk for high blood pressure.
The Department of Cardiology has a comprehensive team approach to managing hypertension and evaluating an athlete's exercise physiology.
More information: 617-355-2079
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