AAP releases guidelines for young athletes with hypertension

Young Player Waiting to BatEarlier this month, the American Academy of Pediatrics (AAP) issued new guidelines concerning young athletes with mildly elevated blood pressure. The guidelines state that youth with high blood pressure are safe to participate in sports, but notes that kids with more serious blood pressure problems need to make training and lifestyle changes before taking part in high-intensity sports or workouts.

“The decision on when an athlete with high blood pressure can safely participate in sports is based on the sport they play and the severity of their blood pressure,” says Bridget Quinn, MD, of Children’s Hospital Boston’s Sports Medicine Program. “High static exercises, like weight lifting and gymnastics, may increase the blood pressure, whereas dynamic exercise, like long distance running and tennis, require more oxygen uptake but have less effect on blood pressure.”

High blood pressure is measured in three categories: pre-hypertension, stage 1 hypertension and stage 2 hypertension. A child with elevated blood pressure is assigned one of these categories based on their blood pressure levels when compared to other kids of the same age, sex and height. Quinn says the level of activity safe for young athletes with hypertension should be based on which category best defines them.

“Athletes with pre-hypertension should continue their activity, including competitive sports, but should have their blood pressure checked every six months. Athletes with stage 1 hypertension, assuming they’re not showing signs of organ damage like an enlarged heart, are fine to continue their normal activities as long as they monitor their blood pressure,” she says. “Athletes with stage 2 hypertension and no organ damage can play sports as long as their blood pressure is controlled with lifestyle changes and/or medications. If their blood pressure isn’t controlled they shouldn’t do high-static sports like martial arts or throwing sports.”

Bridget Quinn, MD
Bridget Quinn, MD

The frequency and intensity of physical activity contributes heavily to a young athlete’s blood pressure, but outside factors can play a part as well. Quinn says avoiding certain products like over-the-counter medication with stimulants, tobacco and caffeinated energy drinks can reduce a young player’s blood pressure and make him or her more fit for strenuous activity on the field.

Obesity and hypertension in young athletes can also be a concern in some sports, especially ones that value size and bulk like football. “Some kids really want to beef up for football season so they’ll increase how much they eat to gain stature,” she says. “But in doing so they place themselves at risk for elevated blood pressure, diabetes, and even trouble sleeping that can place an increased strain on the heart.”

Quinn says the activity levels of kids with hypertension should be monitored more closely than players without high blood pressure, but it shouldn’t restrict them to the sidelines. “We don’t want to discourage exercise in anyone because it has so many great health benefits like helping with weight loss, stress relief, and blood pressure control,” she says. “It’s only really a concern for kids with severely elevated blood pressure, and even then, once the blood pressure is under control, those kids should still be getting regular exercise to stay healthy.”