Association of electrographic left ventricular hypertrophy with incident hypertension among the Tokyo 1964 Olympic athletes: a 50-year follow-up study

Hypertension is an important cardiovascular risk factor that affects cardiac remodeling. Left ventricular hypertrophy (LVH) is a type of cardiac remodeling and a significant risk factor for adverse outcomes. Elite athletes can develop LVH, also called athlete’s heart. While LVH is a reversible change, it is sometimes persistent. It is unclear whether athletes with LVH will suffer from future health disadvantages such as hypertension. Lifestyle-related factors may be involved in long-term health problems; nonetheless, the relationship between LVH and lifestyle is unclear. We investigated the association between LVH and future hypertension in elite athletes, including the effects of lifestyle-related factors. We evaluated the electrocardiographic data of 61 Japanese athletes who participated in the 1964 Tokyo Olympics to determine whether they had LVH, which was evaluated using the Peguero-Lo Presti criteria. Electrocardiographic and follow-up lifestyle data were obtained from the Japan Sport Association study subjects’ biographical information. During the mean follow-up period (47.7 ± 5.1 years), 25 athletes developed hypertension. The LVH group had a significantly higher rate of incident hypertension (60.0% vs. 30.6%, p = 0.02). Multivariate Cox regression analysis revealed that LVH was associated with incident hypertension after adjusting for systolic blood pressure. The relationship was attenuated after including smoking history (LVH: hazard ratio, 2.14; 95% confidence interval, 0.97–4.73; p = 0.06). LVH in athletes was associated with incident hypertension, and smoking attenuated this association. This suggests that LVH is not an independent factor for incident hypertension among elite athletes and that smoking history is an important confounding factor.