IJCS | Volume 32, Nº4, July/August 2019

323 Araújo et al. Exercise/sport & cardiovascular health: an update Int J Cardiovasc Sci. 2019;32(4):319-325 Viewpoint found significant reductions in systolic blood pressure (~5 mmHg) and mean arterial pressure (~3 mmHg) – similar reductions to those reportedwith aerobic exercise training. 19 Reductions in resting blood pressure with IHT seem to be similar between men and women, 19 but whether certain classes of antihypertensive drugs affect IHT efficacy remains unknown. It is also important to note that while IHT may lower resting blood pressure, it is also unclear whether it can modify additional cardiovascular risk factors (e.g. CRF, insulin sensitivity) known to be benefited from aerobic exercise. 18 As a result, the present data supports IHT as an adjuvant exercise-based intervention for hypertensive patients with indications for a similar-intensity dynamic aerobic exercise program. Exercise and sports competition in hypertensive patients Josef Niebauer Q: Until recently, participation in most competitive sport and/or recreational long-distance events (i.e., marathon, triathlons, etc.) was often prohibited for hypertensive patients, even for well-controlled patients. Regarding this very practical and relevant clinical question, where do we stand in 2019? Is it better for hypertensive patients to avoid sports competition, or is it possible to give these patients evidence-based advice and allow them to participate in competitions in a safe way, in terms of risk for cardiovascular events? A: Current guidelines of the European Society of Cardiology advocate regular physical activity as a class IA recommendation for the prevention and treatment of cardiovascular disease. 20 Nonetheless, competitive athletes with arterial hypertension may be exposed to an increased risk of cardiovascular events. Therefore, timely identification of hypertensive individuals is paramount in the setting of pre-participation screening, in order to implement a healthier lifestyle, appropriate management and follow-up. Therefore, it is not so much a question of whether or not athletes should train for and participate in long-distance sporting events, it is more about identifying and treating arterial hypertension to target levels. Indeed, it is endurance exercise that has been shown to have the most beneficial effects not only in hypertensive subjects, yet another reason to train for and participate in long- distance races, in those whose blood pressure has reached normal values, with or without medication. If drugs are needed, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the preferred choice as they do not affect exercise capacity and are not on the doping list. However, they shall not be given to females during reproductive years, because of potential adverse fetal/neonatal effects. While eligibility for competitive sports may have to be restricted if target organ damage is present, an athlete withwell-controlled blood pressure, having no additional risk factors or target organ damage, is eligible for competition in all sports. Details can be found in Niebauer et al., 21 there, a figure can be found on sport disciplines divided according to acute physiologic responses (i.e. heart rate and blood pressure) and long- term impact on cardiac output and remodeling, which is very helpful when recommendations on the type of sports have to be given. Cardiac function and markers after marathon running: the correct interpretation  Jurgen Scharhag Q: Popular participation in long-distance mass events, such as half-marathon, marathon, road cycling, open-water swimming, IronMan etc, has exponentially increased the number of participants in the recent years. Even more interesting, a larger participation of women and a widening in the age of participants – including adolescents and very old subjects – has also been noted. On the other hand, there are several studies suggesting that cardiac markers of undue stress – both biochemical and functional – are triggered by prolonged exercise on the heart of these participants. Do these cardiac markers have clinical relevance or, placing the question from a different perspective, should the cardiologist request any laboratory and imaging tests after the patient completed a mass, recreational sports event? A: During the last two decades, an increasing number of scientific examinations on the effects of endurance exercise on modern cardiac biomarkers have been performed. It has been demonstrated that strenuous endurance exercise usually induces mild increases in the cardiac biomarkers troponin (Tn) I and T and brain natriuretic peptide (BNP) and its N-terminal end (NT- proBNP) in obviously healthy male and female athletes of all ages. The increases seem to depend on age, training status, and exercise time and intensity, with higher increases in older and less trained athletes as well as in more intensive and longer exercise bouts. Nevertheless, increases in cardiac biomarkers in cardiovascular healthy athletes are lower than in patients with acute