Exercise-Induced Hypertension Is Associated with Cardiac Remodeling in Middle-Aged Male Long-Distance Runners: A Cross-Sectional Study

Exercise-induced hypertension (EIH) has been linked to unfavorable cardiovascular outcomes; however, its implications for cardiac structure and function in middle-aged endurance athletes remain unclear. In the present study, cardiac remodeling was assessed using echocardiographic indicators, including left atrial diameter (LAD), left ventricular wall thickness, left ventricular mass (LVM), left ventricular mass index (LVMI), and the E/E′ ratio. This cross-sectional investigation examined 73 male long-distance runners aged 40–65 years, defined as individuals with ≥5 years of running experience and regular endurance training, classified according to maximal systolic blood pressure (SBPmax) during graded exercise testing: an exercise-induced hypertension group (EIHg; n = 35) and a non-EIH group (NEIHg; n = 38). Compared with the NEIHg, runners in the EIHg exhibited greater LAD, wall thickness, LVM, and LVMI (p < 0.05), whereas systolic function did not differ between groups. The E/E′ ratio was higher in the EIHg, suggesting subclinical alterations in diastolic function. LAD correlated with SBPmax, maximal diastolic blood pressure (DBPmax), LVM, and LVMI, while LVMI correlated with SBPmax but not resting systolic blood pressure. E/E′ was associated with DBPmax, LVM, and LVMI. Exploratory multivariable regression analysis showed that peak exercise systolic blood pressure remained associated with LVMI, whereas LAD was associated with SBPmax, BMI, and VO2max. These findings suggest that exaggerated exercise blood pressure responses are associated with cardiac remodeling and early diastolic alterations in middle-aged endurance runners. However, causal relationships cannot be established due to the cross-sectional design.