What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary atherosclerosis and occult hypertension (n=198). Intervention: Occult hypertension (ambulatory and exercise-induced) vs. Normotensive athletes. Primary outcome: CAC score ≥100 AU (OR 2.56, 95% CI 1.08 to 6.04).

What question did this study set out to answer?

This study investigates the link between occult hypertension and coronary atherosclerosis in male masters endurance athletes.

April 26, 2026

Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes

Q: What does this research mean for the field?

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, including elevated CAC scores and coronary stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

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.

Key Points

This study investigates the link between occult hypertension and coronary atherosclerosis in male masters endurance athletes.
198 male masters endurance athletes underwent 24-hour ambulatory blood pressure monitoring and exercise blood pressure assessment.
Coronary CT angiography was used to evaluate coronary artery calcification, luminal stenosis, and plaque features.
39% of athletes were hypertensive based on ambulatory monitoring.
A CAC score of ≥100 Agatston units was significantly associated with ambulatory hypertension (OR: 2.56; 1.08 to 6.04).
A hypertensive response to exercise had strong correlations with coronary stenosis >50% (OR: 4.72; 1.65 to 13.5).

Study Design

Type

Cross-Sectional (n=198)

Structured PICO

Does occult resting or exercise-induced hypertension associate with increased coronary atherosclerosis in male masters endurance athletes?

Population

198 male masters endurance athletes with a low Framingham risk score (<10%) and no clinical diagnosis of hypertension

Intervention

Occult resting hypertension (assessed by 24-hour ambulatory blood pressure monitoring) and exercise-induced hypertension

Comparator

Normotensive athletes

Outcome

Coronary atherosclerosis characteristics including coronary artery calcification (CAC) score, luminal stenosis, and high-risk plaque features assessed by coronary CT angiographysurrogate

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.

Main Result

Effect estimate: OR 2.56 (95% CI 1.08 to 6.04)

Abstract

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 (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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