Key result
Occult hypertension is linked to ~156% higher odds of CAC ≥100 in male endurance athletes.
Why the study?
Recent studies demonstrated a greater prevalence of coronary atherosclerosis in male masters endurance athletes, but the underlying contributors remained unclear.
Does occult resting or exercise-induced hypertension associate with increased coronary atherosclerosis in male masters endurance athletes?
Cross-Sectional (n=198)
Does occult resting or exercise-induced hypertension associate with increased coronary atherosclerosis in male masters endurance athletes?
Effect estimate: OR 2.56 (95% CI 1.08 to 6.04)
Occult resting and exercise-induced hypertension are highly prevalent in male masters endurance athletes and are significantly associated with high-risk features of coronary atherosclerosis.
Supports ABPM and exercise BP testing in masters athletes; leaves open whether treating occult hypertension modifies atherosclerosis risk.
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.
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O’Driscoll et al. (2026) conducted a cross-sectional in Coronary atherosclerosis and occult hypertension (n=198). Occult hypertension (ambulatory and exercise-induced) vs. Normotensive athletes was evaluated on CAC score ≥100 AU (OR 2.56, 95% CI 1.08 to 6.04). Occult hypertension on ambulatory monitoring was associated with CAC score ≥100 AU (OR 2.56; 95% CI 1.08-6.04) and coronary stenosis >50% (OR 2.92; 95% CI 1.17-7.33) in male endurance athletes.
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