High BP Need Not Sideline Most Student Athletes

Competitive sports aren’t off limits for most children with hypertension, according to updated guidelines from the American Academy of Pediatrics.

However, temporary restriction from strenuous sports may be required for student athletes with stage 2 hypertension to reduce risk of cerebrovascular accidents, Rebecca A. Demorest, MD, of Children’s Hospital Oakland in Oakland, Calif., and colleagues wrote in the June issue of Pediatrics.

In the absence of left ventricular hypertrophy, concomitant heart disease, or other end organ damage, these kids can return to competitive athletics after lifestyle measures or medications bring blood pressure back into the normal range, the policy statement said.

No restrictions are needed for those with stage 1 hypertension that reaches at least the 95th percentile for age and height but not more than 5 mm Hg over the 99th percentile (the threshold for stage 2) if there are no signs of end organ damage.

The same holds true for kids with prehypertension, although those with blood pressure between the 90th and 95th percentile need blood pressure checks every six months, Demorest’s group noted.

Lifestyle modifications, including daily physical activity and a balanced diet, was recommended for all three groups as well as for normotensive kids during well-child visits.

Regular, noncompetitive physical activity can be encouraged as an effective strategy to reduce both systolic and diastolic pressures in those with hypertension, the guidelines state.

Young athletes with hypertension, in particular, should be urged to avoid substances that could affect blood pressure, including excessive consumption of energy drinks and caffeine and any exogenous androgens, growth hormones, illicit drugs, alcohol, tobacco in all its forms, nonprescribed stimulants, or over-the-counter supplements that contain ephedra or other stimulants.

Sodium restriction is typically recommended in adult hypertension, but kids participating in competitive sports may need salt-containing sports drinks and other salty foods to stay hydrated after extensive sweating, the statement noted.

It cautioned that student athletes should be advised that antihypertensive diuretics and beta-blockers are on the prohibited list of some athletic governing bodies and that these medications can decrease athletic performance for some individuals.

Careful diagnosis is needed in all cases, with multiple measurements to confirm elevated blood pressure and use of a correctly sized blood pressure cuff, the AAP urged.

But greater care in diagnosing and monitoring hypertension was called for in at-risk populations, which includes obese student athletes.

“In certain sports and team positions, bulk and body mass are valued, expected, and promoted,” Demorest’s group wrote in the statement. “This practice should not be encouraged because of the health risks associated with obesity, including but not limited to hypertension, cardiovascular disease, diabetes, dyslipidemia, and arthritis.”

Another at-risk group is athletes with spinal cord injuries, which can cause difficulties in regulating blood pressure.

“In these athletes, hypertension may be a sign of autonomic dysreflexia (uncontrolled systemic sympathetic response) as a result of pain, illness, infection, or bowel or bladder distension,” the guideline writers noted, emphasizing that intentionally inducing this effect can cause serious health problems.

The new guidelines incorporate updated recommendations from the following:

  * The 2005 Bethesda Conference guidelines for student athletes with heart disease.
  * The brief mention made of exercise in pediatric hypertension in the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.”
  * The 2003 “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” (JNC7).

Primary source: Pediatrics
Source reference: AAP Council on Sports Medicine and Fitness “Policy Statement - Athletic participation by children and adolescents who have systemic hypertension” Pediatrics 2010; 125: 1287-1294.

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