Background Inappropriate high blood pressure response to exercise in non athletes is known to be a predictor for future resting systemic hypertension. However, the relevance of exercise hypertension in endurance athletes is not known.

Objective Assess the differences in heart rate variability (HRV), 24-h ambulatory blood pressure monitoring (ABPM) and lipid profile in athletes with an hypertensive response to exercise, and athletes with normal response to exercise.

Design This study was a prospective cross-sectional study. 47 provincial and national athletes without previous diagnosis of systemic hypertension or other cardiovascular disease, training at least 10 h/week were consecutively recruited. 38 athletes completed the study. Intervention: Athletes underwent an ABPM, a 24-h HRV assessment (Holter), a maximal exercise test and blood samples. Hypertensive response to exercise was defined as systolic blood pressure (SBP) ≥220 mm Hg or diastolic blood pressure (DBP) > 100 mm Hg.

Results Two athletes had systemic hypertension (SBP: 139 ± 3, DBP: 81 ± 8 mm Hg) on 24 h-ABPM and 14 athletes showed hypertensive response to exercise (SBP: 243 ± 20, DBP: 77 ± 13 mm Hg). Lower values of high density lipoprotein (HDL) (1.27 ± 0.19 vs 1.51 ± 0.23 g/L, p=0.04) and Apo-A1 (1.31 ± 0.14 vs 1.56 ± 0.15 g/L, p=0.003) were observed in athletes with hypertensive responses to exercise. The latter also had higher values of night time SBP on ABPM compared to athletes with a normal response to exercise (116 ± 6 vs 106 ± 8 mm Hg, p=0.02). No difference was found between both groups regarding HRV indices.

Conclusion Higher values of night time SBP on ABPM and lower values of HDL and Apo-A1 were observed in athletes with hypertensive response to exercise. These observations may be the first sign of minor metabolic disturbance in endurance athletes, although parameters remain within de normal values.