The Paradox of Performance: Hypertension Among Young Athletes — A Systematic Review and Meta-Analysis of Risks behind Fitness

Abstract Background Hypertension (HTN) is a growing health issue worldwide, with the global burden doubling between 1990 and 2019. Although the disease has traditionally been linked to older people, it is increasingly being discovered in young athletes, which brings into question the cardiovascular health of this group. Objective To assess and establish the incidence rate of hypertension among young competitive sportsmen in different courses taking part in various sporting activities via systematic review and meta-analysis. Methods A PRISMA systematic review was conducted on PubMed, Scopus, and Google Scholar through May 2025 to determine prevalence of hypertension among young athletes (aged < 50 years). A random-effects model was used in R-Studio (version 4.5.0) with I2 statistic to measure heterogeneity. An updated Hoy et al. risk-of-bias tool was used in assessing the study quality. Gender, country, age group (< 20 vs. >20 years), and the value of the hypertension cut-off were used to perform subgroup analyses. Results A total of 26 studies were conducted in 12 countries, involving 54,152 athletes as part of the study. The prevalence of hypertension in young athletes was 9% (95% CI: 5%-12%, P = 0, I2 = 99%). According to the gender analysis, it was identified that 10% of the studies were male-only, 12% were female-only, and 8% were mixed-gender based. The prevalence in the country was widely different: USA (13%), Italy (2%), and Norway (7%). Age-stratified data revealed a prevalence of 12% in athletes under 20 years of age and 4% in those 20 years of age and older. The highest prevalence was observed among NFL players (11%), followed by soccer (10%) and mixed sports (9%). Various definitions of hypertension yielded different prevalence rates: >95th percentile (9 percent), > 130/80 mmHg (20 percent), and > 140/90 mmHg (8 percent), as well as > 140/90 mmHg or taking antihypertensive medications (8 percent). Conclusion The prevalence of high blood pressure in young athletes differs according to gender, geography, type of sport and the definition of diagnosis. Female athletes, US athletes, and NFL players are most prevalent, and need to be screened and intervened more effectively. Clinical trial number: Not Applicable.