Relationship between exaggerated blood pressure response, post-exercise hypotension and age in young elite football players during and after high intensity exercise

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Abstract Introduction Normal blood pressure (BP) during endurance exercise in young healthy individuals is characterized by an increase in systolic BP, while diastolic BP is unchanged or decreases, followed by post-exercise hypotension (PEH). BP during exercise in children depends on sex and age and reference values have been proposed recently. Exaggerated BP response (EBPR) during exercise has been observed in 14% of children, which has been associated with an increased risk of hypertension (HT) in adulthood. Therefore, EBPR and the absence of PEH may serve as early predictors of future HT risk. However, these responses have not been investigated in young elite football players. Purpose This study aimed to determine the development of EBPR and PEH during and after a maximal exercise test in young elite football players, to assess their potential risk of developing HT in adulthood. Methods Young, healthy male football players, aged 14 to 18 years were examined in an elite football academy, and categorized based on football-related age groups: under 15, 16, 17 and 19 (U15, U16, U17, U19). BP was determined at baseline, at maximal exercise and at 5 minutes of post-exercise recovery during treadmill maximal graded cardiopulmonary exercise test. Only athletes who exceeded the anaerobic threshold were included. EBPR, defined in a sex- and age-dependent manner, was assessed as described previously (Sasaki, J Pediatr, 2021), while the absence of PEH was defined as a systolic BP >140 mmHg at 5 minutes of recovery. Results 72 players (15.3±1.3 years, mean±SD) were included in the final analysis, maximal oxygen consumption was 60.4±3.5 mL×kg-1×min-1. No cases of EBPR were observed in the U15 (n=19) and U16 (n=18) groups. However, 13% of U17 (n=15) and 5% of U19 (n=20) players developed systolic EBPR during exercise. Systolic PEH was present in all U15 players, leading to a post-exercise systolic BP decrease compared to baseline (123 vs. 130 mmHg mean, P<0,05), but no significant decrease was detected in the older groups. The prevalence of absent systolic PEH increased with age (5% in U16, 13% in U17, 30% in U19). Diastolic BP decreased during exercise and remained lower at recovery, compared to baseline in all players: U15: 45 vs. 79 mmHg, U16:43 vs. 74 mmHg, U17: 41 vs. 77 mmHg, U19: 39 vs. 75mmHg (mean, P<0,001, in all groups). Conclusions In young, healthy elite football players, the systolic BP during exercise was normal in the U15 and U16 groups, whereas some players in the older age groups exhibited systolic EBPR. Following exercise, all U15 players exhibited systolic PEH, but prevalence of absent systolic PEH increased with age. Diastolic BP decreased during exercise, followed by diastolic PEH in all players. These data in young elite football players show that early markers of increased HT risk, including EBPR and absent systolic PEH, are present in older adolescent players, whereas the normal diastolic BP response may have a protective role.

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