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Association Between Concussion Burden While Playing Professional American-Style Football and Post-Career Hypertension
abstract
This abstract is available on the publisher's site.
Access this abstract nowPrevious work has demonstrated an association between American style football (ASF) and the development of hypertension among collegiate athletes. In addition, hypertension prevalence has been shown to be higher among active professional ASF athletes compared with similarly aged members of the general population. While causal factors including deliberate weight gain, repetitive isometric strength training, sleep apnea, and non-steroidal anti-inflammatory use have been suggested, definitive mechanisms remain incompletely understood. Recent studies in general populations have shown associations between brain injury and subsequent hypertension. Given that ASF players are at particular risk for recurrent head injury, the relationship between concussion history and later life hypertension deserves focused exploration.
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Association Between Concussion Burden During Professional American-style Football and Post-career Hypertension
Circulation 2023 Feb 07;[EPub Ahead of Print], R Grashow, CO Tan, S Izzy, HA Taylor, MG Weisskopf, MM Wasfy, AJ Whittington, F Speizer, R Zafonte, AL BaggishFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Much of the current research on former professional American-style football (ASF) players has focused on neurodegenerative disease and cognitive dysfunction. However, mortality studies have shown that cardiovascular disease remains the leading cause of death in former ASF players.1 Given that former ASF players are likely to have a large body habitus, history of weight gain, use performance-enhancing drugs and prescription pain medication, and are predominantly Black or of minority status, it is unsurprising that cardiovascular dysfunction would be highly prevalent in this population.2 However, until recently, head injury was not regarded as a common risk factor for later-life cardiovascular disease, although a recent study of collegiate ASF athletes showed a widening of pulse pressure after a single season of play.3 A number of large recent studies in patient populations have shown that healthy individuals without cardiovascular, metabolic, psychiatric, and other comorbidities who sustained a single head injury were more likely to receive a diagnosis of hypertension, diabetes, obesity, and coronary artery disease within 5 years post-injury.4-5 It has been established that even short exposures to hypertension can have long-term effects on cardiovascular and cognitive dysfunction in the general population. Understanding the prevalence of hypertension in those exposed to repetitive head injury could offer insight into relationships between head injury and later-life hypertension as well as highlight avenues of targeted interventions that could protect long-term heart and brain health in at-risk populations.
The Football Players Health Study at Harvard University used survey data from over 4000 former professional American-style football players who had a contract with a professional league after 1960.6 Participants were asked about demographic factors, current health conditions, and game and practice-time events, including the frequency of 10 concussion symptoms that occurred during active play after a blow to the head or neck (eg, dizziness, loss of consciousness, nausea, and headaches). The frequency of these symptoms were added together to create a cumulative concussion symptom score (CSS). In this large cohort of former ASF players, CSS was significantly associated with later-life self-reported hypertension after adjusting for age, race, BMI, field position, years of play, smoking, and diabetes. The odds of self-reported hypertension increased in a stepwise manner, such that those with the highest reported concussion symptom burden had twice the odds of a hypertension diagnosis than those with the fewest symptoms.
In conjunction with patient data, the results described here suggest that traumatic brain injury may represent an understudied risk factor for later-life hypertension in athletes exposed to repetitive head injury. These converging findings support the recommendation of preemptive lifestyle adjustments, such as efforts to attain (or maintain) ideal weight, keeping levels of alcohol consumption low, adopting healthy diets (eg, the DASH diet), and evaluating for sleep disorders. Although not yet tested in clinical trials for primordial prevention of hypertension in this unique population, such measures are well-established, prudent, and safe in the general population. Surveillance for and treating hypertension in current and former athletes in contact sports could reduce the long-term cardiovascular disease that has been endemic in former professional ASF players. Furthermore, since there are no current treatments for cognitive dysfunction in former professional ASF players, protecting against known causes of cognitive decline like hypertension with safe and effective pharmacotherapy and lifestyle interventions could reduce some of the cognitive dysfunction burden in this population.
Future studies are needed to better understand the mechanisms that might tie head injury to hypertension. In the meantime, providers are well-advised to recommend evidence-based lifestyle adjustments, enhance surveillance, and encourage avoidance of inertia should hypertension develop in these patients who are at multifactorial risk for later-life cardiovascular and cognitive dysfunction.
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