• hypertension

Regular participation in exercise has long been known to result in cardiovascular adaptation. Historically, the ‘athlete’s heart’ hypothesis has encouraged a dichotomised view of the heart’s adaptation to sport, depending on whether the physical activity was either of isotonic activity (runners and swimmers) resulting in ‘cardiomegaly’ or of isometric effort (wrestlers and shot putters, ie, ‘strength’ athletes) with clear peripheral adaptations and an ‘obvious increase in cardiac size’.1 Today, the classification of sports according to their physiological demands acknowledges a greater diversity of exposure, depending on the physical activity, with an emphasis on a ‘graded transition’ between the main categories: dynamic, static and impact.2 Still, our understanding of the determinants of structural and functional cardiovascular adaptation to exercise are limited, and the consequences for health remain a matter of debate.3

In their  Heart paper, Hedman et al 4 add to the current knowledge beyond the athlete’s heart by presenting data on blood pressure from a large cohort of young athletes. The authors aimed at investigating blood pressure in preparticipation screening, and to evaluate the role of blood pressure against left ventricular (LV) remodelling. Participants’ systolic and diastolic blood pressure was classified according to US and European hypertension guidelines. They observed that one-third of athletes presented with blood pressure exceeding systolic and/or diastolic thresholds of the current US guidelines. Furthermore, systolic blood pressure was associated with LV remodelling and altered diastolic cardiac function, but not systolic function. The findings contribute to our understanding of exercise-induced cardiovascular adaptation, and several …