Hypertension and sports activities: institutional experience.

Findings of 185 patients and 271 control subjects are presented for the assessment of work capacity in hypertensive individuals (primary hypertension); an attempt at classification by hypertensive stage is seen as an essential presupposition. The subdivision into three stages recommended by the Experts' Commission of the WHO places the effects of hypertension on the organism, especially on the heart, in the focal point. This appears justified from a prognostic, pathophysiological, and therapeutic point of view. Hemodynamics in the examined patients undergo increasing impairment in relation to the stage of hypertension with a decrease in maximum cardiac index and work capacity and an increase in myocardial oxygen requirement. Initially, only the diastolic cardiac function is impaired; however, in advanced stages, the systolic function of the heart is impaired as well. Evaluation of work capacity is usually possible from a cardiac point of view by means of noninvasive echocardiographic and spiroergometric methods. The mass/volume ratio of the left cardiac ventricle and the relationship between left ventricular muscle mass (or volume) and work capacity are especially important. Both experience characteristic changes depending on the stage of hypertension and thus permit precise determination of work capacity, progress controls, and delineation from physiological cardiac hypertrophy (athletic heart).

Plasma catecholamine and cardiovascular responses to nifedipine in hypertensives WHO-stage II.

77 patients with arterial hypertension were consecutively examined. An evaluable echocardiogram could be recorded for 75 patients. 54 (72%) had non-pathological cardiac findings, 15 (20%) showed concentric left ventricular hypertrophy of the heart (mean left ventricular muscle mass (LVM) 2.5 g/kg or 113 g/m2; mean LVM/EDV 1.6 g/ml). 6 patients had an excentric hypertrophy of the left ventricle (8%). The influence of 10 mg nifedipine (Adalat) sublingual on the heart, blood pressure and sympathetic activity was examined in 15 patients with left ventricular hypertrophy of the heart. 5-10 min after administration, a significant decrease in systolic and diastolic pressures (p less than 0.05) and an increase in plasma noradrenaline (p less than 0.05) and heart rate (p less than 0.01) could be registered. The thickness of the posterior wall and septum decreased in 8 to 10 of the 15 patients, EDV, shortening fraction and ejection fraction increased in 8 of the 15 patients. A reduction in peripheral resistance, sympathetic counterregulation accompanied by an increase in heart rate, shortening and ejection fractions with increased enddiastolic volume and decrease in wall thickness can be observed as the gross effect in the majority of the 15 patients with left ventricular concentric hypertrophy. The decrease in wall thickness as a relaxation effect should not be confused with a regression of hypertrophy, whereby the mass-volume ratio shifts toward the normal range under nifedipine.

[Follow-up study of 48 athletes with stage I hypertension with and without pharmacotherapy]. / Verlaufsbeobachtung bei 48 Sportlern mit Hypertonie im Stadium I mit und ohne Pharmakotherapie.

We found in an earlier investigation that the frequency of hypertension is considerably lower among male athletes than in a random sample of the general population. The cases of hypertension in younger athletes are primarily hypertension stage I (WHO). We followed up on the question of the course of hypertension stage I and the possibility of spontaneous remission. For this, we observed 28 nonmedicated patients with hypertension stage I for 4.2 +/- 2.3 years, 20 patients undergoing drug therapy for 2.5 +/- 1.3 years, and 12 healthy athletes for 4.2 +/- 2.2 years. Under drug therapy, as expected, there was a normalization of both basic and exercise blood pressures. Fifty percent of patients without drug therapy showed remission of the elevated basic and exercise pressures after 2 to 3 years; 50% had an unchanged high pressure or deterioration. The transition of hypertension WHO stage I to stage II with regard to left ventricular hypertrophy could be ruled out echocardiographically in patients with a favorable course (remission). However, there was a tendency in this direction among patients with the least favorable course.