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

Austin J Rim¹, Chang Liu², Mekensie Jackson¹, James T Miller¹, Nkemka Chukwumerije¹, Rayan El Chami¹, Rand Ibrahim¹, Tanveer Kauser¹, Arthur Miller¹, Erin Simpson¹, W Larsen Vaughn³, Angelo Galante⁴, Craig Clark⁵, Margot Putukian⁶, Rachel Grashow⁷, Aaron L Baggish⁸, Jonathan H Kim⁹

Affiliations

¹ Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
² Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
³ Department of Internal Medicine, Wellstar Kennestone Regional Medical Center, Marietta, Georgia, USA.
⁴ Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA.
⁵ Sports Medicine, Furman University, Greenville, South Carolina, USA.
⁶ Consultant, Chief Medical Officer, Major League Soccer, Princeton, New Jersey, USA.
⁷ Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁸ Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA; Institut des sciences du sport, Universite de Lausanne, Lausanne, Switzerland.
⁹ Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: jonathan.kim@emory.edu.

PMID: 40286373
PMCID: PMC12018548
DOI: 10.1016/j.jacadv.2025.101717

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

Austin J Rim et al. JACC Adv. 2025 May.

. 2025 May;4(5):101717.

doi: 10.1016/j.jacadv.2025.101717. Epub 2025 Mar 24.

Authors

Affiliations

¹ Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
² Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
³ Department of Internal Medicine, Wellstar Kennestone Regional Medical Center, Marietta, Georgia, USA.
⁴ Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA.
⁵ Sports Medicine, Furman University, Greenville, South Carolina, USA.
⁶ Consultant, Chief Medical Officer, Major League Soccer, Princeton, New Jersey, USA.
⁷ Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁸ Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA; Institut des sciences du sport, Universite de Lausanne, Lausanne, Switzerland.
⁹ Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: jonathan.kim@emory.edu.

PMID: 40286373
PMCID: PMC12018548
DOI: 10.1016/j.jacadv.2025.101717

Abstract

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.

Keywords: American-style football; arterial stiffness; athlete; concussion; hypertension; sports.

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Conflict of interest statement

Funding support and author disclosures This work was supported by the NIH/National Heart, Lung, and Blood Institute (R01HL162712 [to Dr Kim]). Dr Kim has received compensation for his role as team cardiologist for the Atlanta Falcons. Dr Baggish has received grant funding/consultancy compensation from the National Football Players Association, American Heart Association, U.S. Olympic Committee/U.S. Olympic Training Centers, U.S. Soccer, and Trek-Lidl Cycling. Dr Grashow has received grant funding from the National Football League Players Association. Dr Putukian is a paid consultant for Major League Soccer and has served as a Team Physician with U.S. Soccer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Figure 1**
Overview of the Collegiate Student-Athlete Cardiovascular Registry and the Concussion Study Protocol

**Figure 2**
Comparison of Changes in Primary Outcome Measures From Baseline Over 2 Complete Collegiate American-Style Football Seasons Concussion = red line; no concussion = blue Line. DBP = diastolic blood pressure; PWV = pulse wave velocity; SBP = systolic blood pressure.

**Central Illustration**
Concussion and Cardiovascular Risk in American-Style Football Athletes LV = left ventricular; other abbreviations as in Figure 2.

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

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