Pre-bout hypertension in the combat sports athlete: clearance recommendations

Figures & data

Table 1. Categories of elevated blood pressure.

	Systolic Blood Pressure (SBP) (mmHg)	Diastolic Blood pressure (DBP) (mmHg)
Normal	< 120	< 80
Elevated	120–129	< 80
Stage 1 Hypertension	130–139	80–89
Stage 2 Hypertension	≥ 140	≥ 90
Severe Hypertension	≥ 160	≥ 100

Adapted from 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults by Whelton PK, Carey RM et al. 2018

Table 2. Common prescription and illicit drugs that can elevate BP.

Prescription drugs	Illicit or street drugs
Antidepressants	Alcohol
Decongestants (e.g. pseudoephedrine, phenylpropanolamine, phenylephrine)	Amphetamines (e.g. methamphetamine, Ecstasy (MDMA), ephedrine)
Atypical antipsychotics	Caffeine
Immunosuppressants (e.g. cyclosporine)	Cocaine
NSAIDs	Pentazocine
Oral contraceptives	Phencyclidine (PCP or Angel Dust)
Corticosteroids	Lysergic acid diethylamide (LSD)
Androgenic Exogenous Hormones

Figure 1. Proposed pre-bout hypertension screening workflow.

Table 3. Suggested expanded history, physical and testing for severely elevated pre-bout blood pressure. For each finding on the left side of the table, its associated possible cause(s) is/are immediately to the right. Athletes with these findings warrant immediate disqualification from competition and need emergent referral for workup and treatment.

History and Review of Systems	Possible Associated Conditions
Neurologic: paralysis, numbness, seizures, nausea, vomiting	Stroke (e.g. carotid dissection, hemorrhagic), Encephalopathy with increased intracranial pressure
Cardiovascular: chest pain, severe back pain	Myocardial infarction, Aortic dissection
Respiratory: dyspnea	Pulmonary edema
Drug use (prescriptions, supplements, street drugs)	Drug-induced hyperadrenergic state, withdrawal syndromes
Examination Findings	Possible Causes
Psychiatric: agitation, delirium	Drugs, encephalopathy
Neurologic: focal neurologic deficits, altered level of consciousness	Stroke, Encephalopathy
Eyes with fundoscopy: pupillary miosis/mydriasis, retinal exudates, papilledema	Drugs, Retinopathy, Encephalopathy
Lungs: fine basilar rales	Pulmonary edema
Testing
Point-of-care drug testing	Drugs