Blood Pressure and Left Ventricular Hypertrophy During American-Style Football Participation

Abstract

Background-Hypertension, a strong determinant of cardiovascular disease risk, has been documented among elite, professional American-style football (ASF) players. The risk of increased blood pressure (BP) and early adulthood hypertension among the substantially larger population of collegiate ASF athletes is not known. Methods and Results-We conducted a prospective, longitudinal study to examine BP, the incidence of hypertension, and left ventricular remodeling among collegiate ASF athletes. Resting BP and left ventricular structure were assessed before and after a single season of competitive ASF participation in 6 consecutive groups of first-year university athletes (n=113

American‐Style Football and Cardiovascular Health

“…Weiner et al observed similar and significant increases in LV mass among collegiate ASF athletes with concentric LV hypertrophy (LV mass index >115 g/m 2 and relative wall thickness >0.42), occurring more frequently among linemen compared with nonlinemen (20/24 [83%] versus 1/12 [8%]; P <0.001) 14. The observation that the development of concentric LV hypertrophy was associated with intraseason changes in SBP and absolute postseason SBP suggests an element of subclinical hypertensive cardiac remodeling rather than simply benign exercise‐mediated adaptive remodeling.…”

“…The development of concentric LV hypertrophy among ASF participants has been demonstrated by several longitudinal observational studies 14, 17, 64. Weiner et al observed similar and significant increases in LV mass among collegiate ASF athletes with concentric LV hypertrophy (LV mass index >115 g/m 2 and relative wall thickness >0.42), occurring more frequently among linemen compared with nonlinemen (20/24 [83%] versus 1/12 [8%]; P <0.001) 14.…”

“…In this cross‐sectional analysis (first‐year “rookie” players were excluded), hypertension (13.8% [95% CI, 11–16.7%]) and prehypertension (64.5% [95% CI, 58.3–70.7%]) were significantly more common in the ASF cohort compared with age‐matched controls (5.5% [95% CI, 4.6–6.6%] and 24.2% [95% CI, 22.3–26.1%], respectively), despite 30% prevalence of active tobacco use among the controls. A strong association between ASF participation and incident hypertension was established in collegiate ASF athletes 14, 16, 17. In a longitudinal, repeated‐measures study of 113 freshman ASF athletes followed across seasonal training, there were significant increases in both SBP (116±8 versus 125±13 mm Hg, P <0.001) and diastolic blood pressure (DBP; 64±8 versus 66±10 mm Hg; P <0.001) from the pre‐ to postseason, with 61% of the cohort meeting criteria for either elevated blood pressure (SBP 120–129 mm Hg, DBP <80 mm Hg), stage 1 hypertension (SBP 130–139 mm Hg, DBP 80–89 mm Hg) or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg) at the time of immediate postseason assessment 14, 51.…”

“…In the largest reported cohort of professional ASF athletes (n=504), the mean BMI was 31.4 (95% confidence interval [CI], 31.3–31.6) with offensive linemen (37.8 [95% CI, 37.3–38.2]) and defensive linemen (35.7 [95% CI, 34.9–36.6]) demonstrating significantly higher BMI than athletes at nonlineman field positions 12. A causal relationship between ASF participation and elevated BMI is suggested by several relatively short‐duration longitudinal studies that consistently document weight gain, particularly among linemen, during a single season of collegiate ASF participation 14, 18. However, it must be emphasized that although BMI is a validated marker of cardiac risk in the general population, its prognostic significance among elite ASF athletes has not been similarly established.…”

“…In healthy nonathletic populations, early onset cardiovascular risk and attendant subclinical pathology at ages typical of ASF athletes predict later life cardiovascular morbidity and mortality 9, 10, 11. Although this phenomenon has not been firmly established among ASF participants, a growing body of observational data documents associations among large body mass,12, 13 early life hypertension,12, 14 and subclinical pathologic cardiovascular phenotypes15, 16, 17, 18 in ASF athletes. In addition, epidemiologic outcomes data from former professional ASF athletes suggest accelerated cardiovascular mortality among former lineman‐position players 19, 20.…”