Background High blood pressure (BP) is a leading cause of illness, and bilateral measurement of BP is recommended in IOC's preparticipation health examination. Still there is limited data on BP in elite athletes.

Objective To describe blood pressure, prevalence of hypertension and subclinical organ damage (left ventricular hypertrophy) in elite athletes.

Design Systematic review, using a comprehensive search strategy developed for PubMed.

Setting We identified studies of BP in elite athletes, including only studies of ≥100 athletes. Of 2049 studies identified, only 40 studies met the inclusion criteria.

Participants Elite athletes aged 18 to 35 years.

Assessment of risk factors High BP; Left ventricular hypertrophy.

Main outcome measurements Office and ambulatory BP; Prevalence of hypertension; Method of BP measurement; Associations between BP and left ventricular hypertrophy (determined by voltage criteria on ECG or left ventricular mass on echocardiography).

Results Office BP was recorded from one to three times at each visit, and measurements were repeated at different time intervals in nine studies. Only one study measured BP in both arms, and only two studies measured ambulatory BP if office BP was high. Mean systolic BP varied from 112±11 mmHg to 138±7 mmHg and mean diastolic BP from 59±8 mmHg to 86±7 mmHg. Hypertension was not defined or defined differently, from ≥130/85 mmHg to ≥150/95 mmHg, and the prevalence of hypertension varied from 0 to 45%. Athletes of both genders and from different sports disciplines were mixed in half of the studies. Four studies showed an association between increased BP and left ventricular hypertrophy.

Conclusions Definition and prevalence of hypertension and methods of BP measurement differed substantially between the studies, and only a few studies investigated the association between high BP and subclinical organ damage. Future studies should use standardised definitions and methods, and hypertension as a risk factor in athletes should be further investigated.