Concussions Are Associated With Increases in Blood Pressure and Cardiovascular Risk in American-Style Football Athletes

BACKGROUND: Concussions sustained during American-style football (ASF) participation are common. Whether concussions are associated with cardiovascular risk is unknown. OBJECTIVES: The authors sought to determine whether concussions sustained during collegiate ASF participation lead to increases in systolic blood pressure (SBP) and acquired maladaptive cardiovascular phenotypes. METHODS: In a longitudinal and case-controlled analysis, ASF athletes at 2 National Collegiate Athletic Association Division-I programs were followed for up to 2 years with cardiovascular assessments including BP, echocardiography, and vascular applanation tonometry. ASF athletes who sustained clinically diagnosed concussions were compared to weight and player position-matched controls without concussions. RESULTS: Thirty-nine ASF athletes who sustained concussions (preconcussion baseline: [SBP] 129.6 ± 13.6 mm Hg) and 39 weight and player position-matched controls (preconcussion baseline: [SBP] 131.6 ± 13.1 mm Hg) were followed for 1 season postconcussion; 14 of these pairs were followed through 2 seasons. After 1 season, increased pulse wave velocity (PWV) (case Δ = 0.4 [0.2] m/s, P = 0.036; control Δ = -0.1 [0.1] m/s, P = 0.38) was observed among cases. Among the case and control pairs followed over 2 seasons, increased SBP (case Δ = 10.1 [3.6] mm Hg, P < 0.01; control Δ = 0.1 [3.2] mm Hg, P = 0.97) and diastolic blood pressure (case Δ = 8.2 [2.9] mm Hg, P < 0.01; control Δ = -4.1 [4.0] mm Hg, P = 0.30) and decreased É (case Δ = -2.8 [0.8] cm/s, P = 0.001; control Δ = -1.0 [0.8] cm/s, P = 0.21) were observed among cases. Over 1 season, concussions were associated with higher PWV (β = 0.33 [95% CI: 0.09-0.56], P = 0.007). Among athletes followed over 2 seasons, concussions were associated with higher PWV (β = 0.42 [95% CI: 0.05-0.78], P = 0.03), diastolic blood pressure (β = 5.89 [95% CI: 1.23-10.54], P = 0.01), LV mass index (β = 11.01 [95% CI: 6.13-15.90], P < 0.001), and lower É (β = -2.11 [95% CI: -3.27 to -0.95], P < 0.001). CONCLUSIONS: Concussions sustained during collegiate ASF participation are independently associated with markers of cardiovascular risk and acquired maladaptive cardiovascular phenotypes. Clinical ASF concussion management strategies inclusive of careful BP surveillance may lead to early identification of hypertension.