{
  "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 (<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.",
  "authors": [
    {
      "affiliations": [
        "Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK",
        "Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK",
        "St George’s University Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Jamie O’Driscoll"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Gemma Parry-Williams"
    },
    {
      "affiliations": [
        "Department of Radiology, St George’s University Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Joanna Moser"
    },
    {
      "affiliations": [
        "University of Texas MD Anderson Cancer Centre Brain Tumor Centre, Houston, Texas, USA"
      ],
      "name": "Ioannis Vlahos"
    },
    {
      "affiliations": [
        "Institute of Life Sciences, Swansea University Medical School, Swansea, UK"
      ],
      "name": "Daniel Obaid"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Joyee Basu"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Gherardo Finocchiaro"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Saad Fyyaz"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Hamish MacLachlan"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Sarandeep Marwaha"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Chris Miles"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Efstathios Papatheodorou"
    },
    {
      "affiliations": [
        "Cardiologia Centro, Azienda Ospedaliero-Universitaria di Parma, Parma, Emilia-Romagna, Italy"
      ],
      "name": "Nicola Gaibazzi"
    },
    {
      "affiliations": [
        "Cardiologia Centro, Azienda Ospedaliero-Universitaria di Parma, Parma, Emilia-Romagna, Italy"
      ],
      "name": "Domenico Tuttolomondo"
    },
    {
      "affiliations": [
        "Biomedical Imaging Research Institute, Cedars-Sinai, Los Angeles, California, USA"
      ],
      "name": "Damini Dey"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK"
      ],
      "name": "Maximiliano Moreira"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK"
      ],
      "name": "Athanasios Bakalakos"
    },
    {
      "affiliations": [
        "Department of Medical BioSciences, Exercise Physiology Research Group, Radboud University Medical Centre, Nijmegen, The Netherlands"
      ],
      "name": "Thijs Eijsvogels"
    },
    {
      "affiliations": [
        "Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands"
      ],
      "name": "Vincent Aengevaeren"
    },
    {
      "affiliations": [
        "Institute of Sport, Manchester Metropolitan University, Manchester, UK"
      ],
      "name": "Aneil Malhotra"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK"
      ],
      "name": "Maria Tome-Esteban"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Rajan Sharma"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK",
        "Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, UK"
      ],
      "name": "Michael Papadakis"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s University of London, London, UK",
        "Cardiovascular Clinical Academic Group, St George’s University of London, London, UK",
        "Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, UK"
      ],
      "name": "Sanjay Sharma"
    }
  ],
  "title": "Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes",
  "uid": "f51cce50-c83a-54cc-b66d-1c99826b947d"
}