Exercise-induced Hypertension and Cardiovascular Remodeling in Middle-aged Male Marathon Runners: A Narrative Review

BACKGROUND: Regular aerobic exercise is a cornerstone of cardiovascular disease prevention, but the growing participation of middle-aged men in marathon and ultramarathon running raises concerns about the interplay between endurance training, blood pressure regulation, and cardiac remodeling. Exercise-induced hypertension, defined as an exaggerated blood pressure response to physical exertion, has emerged as an important but underrecognized risk factor in this populación. This narrative review aims to summarize current evidence on the relationship between exercise-induced hypertension, arterial stiffness, and cardiovascular remodeling in amateur male marathon runners aged 35-50 years, and to define the boundaries between physiological adaptation and hypertensiondriven pathological restructuring of the myocardium. METHODS: A narrative review of the literature (2010-2026) was conducted using PubMed, Scopus, and Web of Science. Studies employing office and ambulatory blood pressure monitoring, echocardiography (including septal geometry and indices of diastolic function), cardiac magnetic resonance imaging, arterial stiffness assessment, and cardiac biomarker analysis (including sST2 and galectin- 3) in endurance-trained non-professional athletes were included. RESULTS: Moderate aerobic training reduces resting blood pressure and improves endothelial function, whereas excessive workloads exceeding 100-120 km per week are associated with exaggerated exercise blood pressure responses, increased arterial stiffness, atrial fibrillation, and myocardial fibrosis. Amateur marathon runners frequently exhibit transient elevation of conventional cardiac biomarkers, as well as post-race increases in fibrosis-related biomarkers (sST2, galectin-3) and reversible myocardial strain reduction. Exercise-induced hypertension is associated with early echocardiographic signs of hypertensive remodeling, including septal bulge formation and subclinical diastolic dysfunction (elevated E/e' ratio). DISCUSSION: Exercise-induced hypertension appears to be a mechanistic link between chronic highvolume endurance training and adverse cardiac remodeling, particularly in middle-aged men with subclinical vascular aging or latent hypertension. CONCLUSION: Individualized blood pressure screening, monitoring of arterial stiffness, and structured recovery are essential for safe marathon participation in men aged 35-50 years.