High Blood Pressure & Cardiovascular Prevention

, Volume 25, Issue 4, pp 385–390 | Cite as

Left Ventricular Hypertrophy in Hypertensive Athletes can be Reduced by Antihypertensive Medication Despite Continuing Intense Aerobic Exercise

  • Sascha KetelhutEmail author
  • Ingomar W. Franz
  • Reinhard G. Ketelhut
Original Article



Left ventricular hypertrophy (LVH) can be successfully reduced by antihypertensive medication. Both hypertension and aerobic exercise can cause increases in left ventricular mass (LV-mass).


Therefore, hypertensive athletes with LVH were studied to investigate the effect of antihypertensive medication on LV-mass reduction despite continuing their regular intensive exercise programs.


14 previously untreated hypertensive male athletes (A) with LVH and a prolonged history of endurance training where included in the study. 50 previously untreated inactive comparable hypertensives with LVH served as controls (C). For both groups inclusion criteria were blood pressure (BP) at rest: > 140/90 mmHg, BP during ergometry (at 100 W): > 200/100 mmHg and. LV-mass-index > 125 g/m2. Echocardiography was performed to calculate LV-mass and function before and after 3 years of antihypertensive medication.


Despite regularly aerobic training throughout the treatment period, LV mass decreased from 164 ± 19 g/m2 before to 97 ± 16 g/m2 after 3 years of therapy (p < 0.001). Controls with identical pressures demonstrated a decrease from 149 ± 29 g/m2 to 87 ± 15 g m2. There were similar decreases in LV wall thicknesses in both groups, whereas diastolic dimensions did not change significantly. Moreover, there was an increase in fractional fiber shortening as a measure of LV pump function in both groups of 15% in A and 11% in C, respectively.


In hypertensive athletes LVH due to hypertension can be reduced and LV-function can be improved by long-term antihypertensive medication despite regular aerobic exercise. Therefore, exercise does not interfere with the regression of LVH on account of antihypertensive therapy in hypertensive subjects.


Left ventricular hypertrophy Hypertension Aerobic exercise Exercise training Antihypertensive treatment Blood pressure 



The authors thank the participants for taking part in the project and the Medical Center Berlin (MCB) for the opportunity to using their medical equipment.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Moore RL, Palmer BM. Exercise training and cellular adaptations of normal and diseased hearts. Exerc Sport Sci Rev. 1999;27:285–315.CrossRefGoogle Scholar
  2. 2.
    Levy D, Garrison RJ, Savage DD, Kannel WB, Catelli WP. Prognostic implications of echocardiographic determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.CrossRefGoogle Scholar
  3. 3.
    Kannel WB. Left ventricular hypertrophy as a risk factor: the Framingham experience. J Hypertens. 1991;9(2):53–9.Google Scholar
  4. 4.
    Gradman AH, Alfayoumi F. From left ventricular hypertrophy to congestive heart failure: management of hypertensive heart disease. Prog Cardiovasc Dis. 2006;48:326–41.CrossRefGoogle Scholar
  5. 5.
    Verdecchia P, Angeli F, Borgioni C, Gattobigio R, de Simone G, Devereux RB. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens. 2003;16:895–9.CrossRefGoogle Scholar
  6. 6.
    Lee AKY, Morrison B, Isserow SH, Heilbron B, Krahn AD. The impact of excessive endurance exercise on the heart. BCMJ. 2016;58(4):203–9.Google Scholar
  7. 7.
    De Matos LD, Caldeira Nde A, Perlingeiro Pde S, dos Santos IL, Negrao CE, Azevedo LF. Cardiovascular risk and clinical factors in athletes: 10 years of evaluation. Med Sci Sports Exerc. 2011;43(6):943–50.CrossRefGoogle Scholar
  8. 8.
    Williams PT. Vigorous exercise, fitness and incident hypertension, high cholesterol, and diabetes. Med Sci Sports Exerc. 2008;40(6):998–1006.CrossRefGoogle Scholar
  9. 9.
    Ketelhut RG, Franz IW, Scholze J. Regular exercise as an effective longterm approach in antihypertensive therapy. Med Sci Sports Exerc. 2004;1:4–8.CrossRefGoogle Scholar
  10. 10.
    Franz IW. Ergometry in hypertensive patients. Berlin: Springer; 1986.CrossRefGoogle Scholar
  11. 11.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.CrossRefGoogle Scholar
  12. 12.
    Frey I, Berg A, Gratwohl D, Keul J. Freiburger Fragebogen zur körperlichen Aktivität—Entwicklung, Prüfung und Anwendung. Soz Präv. 1999;44:55–64.CrossRefGoogle Scholar
  13. 13.
    Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux RB, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.CrossRefGoogle Scholar
  14. 14.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. American Society of Echocardiogrpahy’s Nomenclature and Standards Committee: Task Force on Chamber Quantification: American College of Cardiology Echocardiography Committee; American Herat Association, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.CrossRefGoogle Scholar
  15. 15.
    Franz IW, Ketelhut RG, Behr U, Tönnesmann U. Time course of reduction in left ventricular mass during long-term antihypertensive therapy. J Hum Hypertens. 1994;8:191–8.PubMedGoogle Scholar
  16. 16.
    De Sá Perlingeiro P, Azevedo LF, Gomes-Santos IL, Bortolotto LA, Rondon MU, Negrão CE, De Matos LD. Neurovascular control and cardiac structure in amateur runners with hypertension. Med Sci Sports Exerc. 2016;48(1):26–32.CrossRefGoogle Scholar
  17. 17.
    Rossi MA. Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans. J Hypertens. 1998;16:1031–41.CrossRefGoogle Scholar
  18. 18.
    Turpeinen AK, Kuikka JT, Vanninen E, Vainio P, Vanninen R, Litmanen H, et al. Athletic heart: a metabolic, anatomical, and functional study. Med Sci Sports Exerc. 1996;28:33–40.CrossRefGoogle Scholar
  19. 19.
    Maron BJ. Structural features of the athlete’s heart as defined by echocardiography. J Am Coll Cardiol. 1986;7:190–203.CrossRefGoogle Scholar
  20. 20.
    George KP, Wolfe LA, Burggraf GW, Norman R. Electrocardiographic and echocardiographic characteristic of female athletes. Med Sci Sports Exerc. 1995;10:1362–70.Google Scholar
  21. 21.
    Caselli S, Maron MS, Urbano-Moral JA, Pandian NG, Maron BJ, Pelliccia A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol. 2014;114(9):1383–9.CrossRefGoogle Scholar
  22. 22.
    Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82:521–4.CrossRefGoogle Scholar
  23. 23.
    Landry F, Bouchard C, Dumesnil J. Cardiac dimension changes with endurance training: indications of a genotype dependency. JAMA. 1985;254:77–80.CrossRefGoogle Scholar
  24. 24.
    Claessens PJM, Claessens CWF, Claessens MMM, Claessens MCF, Claessens JEJ. Supernormal left ventricular diastolic function in triathletes. Tex Heart Inst J. 2001;28:102–10.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Sen S. Regression of cardiac hypertrophy: experimental animal model. In: Messerli FH, editor. The heart in hypertension. New York: Yorke Medical; 1987. p. 325–35.Google Scholar
  26. 26.
    Asmar RG, Journo JH, Lacolley PJ. Treatment for one year with perindopril: effect on cardiac mass and arterial compliance in essential hypertension. J Hypertens. 1988;6(3):33–9.Google Scholar
  27. 27.
    Franz IW, Behr U, Ketelhut R, Agrawal B. Regression of left ventricular hypertrophy from systemic hypertension by gallopamil. J Cardiovasc Pharmacol. 1987;10(10):178–81.CrossRefGoogle Scholar
  28. 28.
    Franz IW, Tönnesmann U, Behr U, Ketelhut R. Long-term effect of antihypertensive therapy on left ventricular hypertrophy. J Hypertens. 1987;5(5):415–8.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Institute of Sport ScienceMartin-Luther-University Halle-WittenbergHalle (Saale)Germany
  2. 2.Klinik WehrawaldTodtmoosGermany
  3. 3.Medical Center Berlin (MCB)BerlinGermany
  4. 4.Institute of Sports ScienceHumboldt-UniversityBerlinGermany

Personalised recommendations