Ringside Physicians Discuss Safe Pre Bout Blood Pressure Metrics for Fighters

A paper was published in the latest edition of the journal The Physician and Sportsmedicine discussing recommended blood pressure thresholds for clearing combat sports athletes for competition.

The full article, titled Pre-bout hypertension in the combat sports athlete: clearance recommendations, can be found here. After discussing the risks of athletes competing with elevated blood pressure the authors go on to make the following recommendations:


it is the recommendation of the authors of this manuscript that
a pre-bout blood pressure threshold for disqualification of SBP
≥ 160 mmHg and/or DBP ≥ 100 mmHg be established as
a guideline to sound clinical judgment. These thresholds are
consistent with the American College of Sports Medicine, the
American Heart Association, and the American College of
Cardiology. As combat sports athletes have high levels of
static and dynamic vascular stress and are at risk of head
trauma, ignoring these recommendations would be unwise
and could place athletes at unnecessary increased risk of
adverse events.

The full abstract reads as follows:

Hypertension is one of the most prevalent medical disorders in the world and is associated with
significant cerebrovascular and cardiovascular morbidity. Pre-bout blood pressure (BP) elevation is
extremely common, and ringside physicians must accurately assess the accompanying risk of adverse
cerebrovascular and cardiovascular events in the decision to allow participation in combat sports. It is
strongly recommended that a ringside physician consider disqualifying a combat sports athlete with
severe pre-bout hypertension (systolic BP ≥160 mm Hg and/or diastolic BP ≥100 mm Hg, or stage 2
hypertension in children when indexed by gender, age, and height) from that bout, if it persists despite
rest and repeated measurement with accurate equipment. This recommendation is congruent with that
of the American College of Sports Medicine, the American College of Cardiology, and the American
Heart Association, which recommend non-clearance for sports or exercise testing when BP exceeds
those thresholds. Severely elevated BP, as defined above, confers markedly increased risk of morbidity
and mortality. Exercise further raises BP markedly. The combination of severely elevated blood pressure
and cranial trauma during combat sports is a risk factor for intracranial hemorrhage with a direct impact
on the morbidity and mortality associated with ringside combat sports events. Combat sports athletes
with SBP ≥130 or DBP ≥90 – and their coaches and families, if available and the athlete consents –
should be educated on the causes of hypertension, its acute and chronic risks, and the possible future
implications for bout clearance, and the athletes should be referred for evaluation and management.


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