Professional American football players who experience repeat concussions during years of active play may be at increased risk for hypertension and poor cardiovascular health later in life, according to study findings published in the journal Circulation.

Previous research has revealed a connection between American football and the onset of hypertension among collegiate athletes. Professional American football players are at increased risk for repeated head injuries, leading to the question if recurrent concussions are related to the development of hypertension later in life.

Researchers participating in the Football Players Health Study at Harvard University conducted a survey of former professional American football players, obtaining self-reported data on concussion burden, severity, and symptom frequency to calculate the concussion symptom score (CSS) on a scale of 0-130. The researchers quantified concussion burden by the occurrence and severity of these common concussion symptoms: headaches, nausea, dizziness, confusion, loss of consciousness, memory problems, seizure, visual problems, disorientation, and feeling unsteady on one’s feet. They determined a diagnosis of hypertension according to physician prescription of antihypertensives.

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Other collected data included information on National Football League career duration, position played, current smoking status, age, ethnicity, history of diabetes, body mass index (BMI), and years since last play.

A total of 4,168 former professional American football players (mean age, 51.8 years; 39.4% were Black; mean BMI was 31.3; and 33.9% were linemen) completed the study. Participants played for a mean of 6.7 seasons and were surveyed at 24.1 years post career completion. The reported median CSS was 23.

Out of 4,168 respondents, 1542 (37.3%) reported hypertension while 368 (8.8%) had diabetes. Following adjustments for known risk factors for hypertension including race, age, diabetes, smoking, and BMI, the researchers discovered a graded correlation between CSS and later onset of hypertension in these professional American football players. Higher concussion exposure correlated with prevalent hypertension.

When the researchers substituted loss of consciousness, a severe symptom of concussion, for CSS, results were similar.

“In this large cohort of former professional ASF players, we found a significant association between concussion symptom burden during years of active play and odds of post-career hypertension,” the researchers noted.

Hypertension has been shown to independently increase the risk for cognitive decline. The researchers highlight that “some element of cognitive decline among former ASF [American-style football] players may be attributable to hypertension, a disease that is responsive to lifestyle intervention and pharmacotherapy.” However, they warrant future studies should clarify the associations and casual pathways between brain injury, hypertension, and brain health.

“These results suggest that repetitive early-life brain injury may have later life implications for cardiovascular health,” they concluded.

Study limitations included self-reported concussion and hypertension data, potential selection bias, and confounding variables that may have also contributed to the development of hypertension following brain injury.

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.


Grashow R, Tan CO, Izzy S, et al. Association between concussion burden during professional American-style football and post-career hypertensionCirculation. Published online February 7, 2023. doi:10.1161/CIRCULATIONAHA.122.063767

This article originally appeared on Neurology Advisor