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College football players at risk for high BP, LV hypertrophy
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Participation in American-style football has been linked to increased BP and risk for hypertension among first-year college athletes. For linemen, playing football was associated with increased risk for concentric left ventricular hypertrophy, according to results of a prospective, longitudinal study.
Previous studies have shown that professional football players are at risk for hypertension, LV hypertrophy and premature CV mortality; however, it was not known whether the same risks are present in high school or college football players.
Aaron L. Baggish
“What our data shows is that, as with concussion, hypertension and high BP should be another part of routine screening for young, healthy people,” Aaron L. Baggish, MD, associate director of the Cardiovascular Performance Program at Massachusetts General Hospital, told Cardiology Today. “We have spent a lot of effort talking about screening athletes before they play, but we pay comparatively less attention to screening once that decision is made” to let them play.
Risks increased
The researchers studied newly matriculated male varsity football players (n=113; mean age, 19 years; 64 linemen; 62% white). All were part of the Harvard Athlete Initiative at Harvard University from 2006 to 2011. Each participant had BP and underwent a transthoracic echocardiogram before and after his first season of playing college football.
According to the findings, participation in football was associated with increased systolic BP (116 ± 8 mm Hg vs. 125 ± 13 mm Hg; P<.001) and increased diastolic BP (64 ± 8 mm Hg vs. 66 ± 10 mm Hg; P<.001). BP measurements recorded after the first season showed that most football participants met the criteria for Joint National Commission (seventh report) prehypertension (47%) or stage I hypertension (14%). Participants most likely to have elevated BP were those who played a line position, those who gained weight during the season and those with a family history of hypertension.
The prevalence of LV hypertrophy increased in linemen during the season (3% before the season vs. 31% after the season; P<.001). Changes in LV mass correlated with systolic BP changes (R=0.46; P<.001).
“Our analyses suggest that the concentric LV hypertrophy in this population is caused in part by increases in resting BP, not simply by the transient isometric stress that occurs during training and competition,” Baggish and colleagues wrote.
The researchers also performed an identical study of male endurance rowers (n=70; mean age, 19 years) who completed a 90-day endurance-based training program to assess whether changes observed in the football players were unique to football participation. The rowing participants did not show an increase in BP during the course of the college football season. This “indicates that the BP increase and the development of hypertension are not a uniform response to all forms of vigorous exercise training,” Baggish and colleagues wrote.
Linemen tended to have the highest risk because they gained more weight during the season and participated in more power-based activities as opposed to more endurance-based ones, Baggish said in an interview.
Call for attention, not alarm
Baggish cautioned against overreaction to the data.
“The findings are not cause for alarm as much as they are for piqued interest,” he told Cardiology Today. What doctors can do, he said, is realize that “[college] football players are a new population that we know is at risk for high BP. If the patient is a lineman, has gained weight, or has a family history of hypertension, check his BP before, during and after the season at some interval that works for the doctor and patient.”
Disclosure: Baggish reports no relevant financial disclosures.
Perspective
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Stephen Daniels, MD, PhD
It’s an interesting study and will generate some discussion, and the idea will extend down to the high school level, which will be good. One study can be important, but we need other studies to confirm this. The study has confirmed some things that we know. We know, for example, that BP elevation is associated with being overweight. Especially in some football players, being overweight is an issue. We also know that BP elevation can also be related to use of performance-enhancing drugs. I’m not sure that that’s happening here, but it’s certainly one thing that, from a clinical standpoint, you would want to ask a football player who presents with new elevation of BP. We also know that college athletes — and all college students — are at a time period where they are making that transition from adolescence to adulthood, and there are certain things going on in the CV system and elsewhere that make them more prone to high BP and to other CV changes. This study brings a number of those things together, which is useful.
We ought to be paying attention to college athletes — and this extends to high school athletes as well — to be sure they have their BP measured and follow their BP over time, even during the season. You could have an individual with normal BP during screening, but checking it during the year may be a useful concept. College athletes are a select, relatively small subset. If you expand it to high school athletes, that becomes a much bigger arena. We need to know more about experiences in other sports and among women, so we know exactly how generalizable this is.
There’s a sense that high school coaches may be telling players that they need to be bigger, and sometimes the kids interpret that as they need to be heavier. As they gain weight, they’re certainly more prone to increased BP, especially if they have a family history of hypertension. So we do see this to a certain extent in high school athletes. I don’t think we’ve had quite as systematic a study about it. This may be an area where we need more data to understand the issue better.
One strategy for prevention is to focus on avoiding gain of fat mass. Gain of lean body mass, muscle mass, etc, should be the focus. Avoiding obesity is a good message for football players and the population at large. This creates an opportunity to talk about performance-enhancing drugs and why athletes at the college and high school levels should be avoiding those. It creates opportunities to talk about healthier eating. Different schools may have different approaches to the training table. What would help with prevention is to focus on fruits and vegetables, lean meats, etc, rather than on the high-carbohydrate, high-fat types of items that might be present on some training tables.
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