TY  -  JOUR
AU  -  Ballatore, Tommaso
T1  -  Arterial hypertension and non-competitive sports fitness certification: an operational framework based on the 2024 ESC Guidelines
PY  -  2026
Y1  -  2026-06-01
JO  -  Medicina dello Sport
JA  -  Med Sport
VL  -  79
IS  -  2
SP  -  100
EP  -  107
PB  -  Il Pensiero Scientifico Editore
SN  -  1827-1863
Y2  -  2026/07/24
N2  -  Summary. Background. Arterial hypertension is the most frequently encountered clinical condition in non-competitive sports fitness certification in Italy, with a prevalence exceeding 30% in adults over 45 years. The Ministerial Decree of 24 April 2013 provides no operational thresholds for the certification assessment. The 2024 ESC Hypertension Guidelines introduced a new three-category blood pressure classification and the recommendation of 150 minutes per week of aerobic exercise as a Class I-A intervention, with direct implications for the Italian certifying physician not yet systematically addressed. Objective. To propose an operational framework for the certification assessment of hypertensive subjects, consistent with the 2024 ESC Hypertension Guidelines, integrating available evidence with practical proposals derived from the author’s clinical experience. Methods. Position paper based on a PubMed and ESC/AHA/ACC bibliographic search (2020–2026; terms: “hypertension exercise”, “blood pressure physical activity”, “sports cardiology hypertension”, “pre-participation screening”), within the Italian regulatory framework. The operational certification thresholds and documentation model are the author’s proposals, not derived from official guidelines. Results. The 2024 ESC Guidelines introduce the ‘elevated BP’ category (120–139/70–89 mmHg) with a Class I-A exercise recommendation: the certification process may indirectly facilitate adherence to guideline-recommended lifestyle interventions, without constituting a formal therapeutic act. For the 140–160/90–100 mmHg range, an individual-choice approach with three structured options is proposed. Drug–exercise interactions are categorized for the clinical letter. Conclusions. The 2024 ESC Guidelines modify the clinical context of non-competitive certification. The proposed framework – operational thresholds, decision model, dual-version documentation tools for privacy protection – is applicable in routine practice and may help strengthen the documentation of the clinical decision-making process, while representing the author’s proposal and not an official recommendation.
ER  -