High Prevalence of
Hypertension Among Collegiate Football Athletes

AR, Roumie CL, Nian H, Diamond AB,
Rothman RL.
Circ Cardiovasc Qual Outcomes.  2013;6:00-00.

Take Home Message:  College football athletes may have a higher
prevalence of hypertension than college male nonfootball athletes. 

physical activity is an established means of reducing blood pressure; however,
a recent study of National Football League players
found that they had a higher prevalence of hypertension compared with the
general population – 14% versus 6%.  It
is challenging to know if these findings are applicable to college football
athletes because there is limited research in this area. Therefore, Karpinos and
colleagues conducted a retrospective cohort study
to determine the prevalence of hypertension among collegiate football athletes
compared with nonfootball male athletes. 
The authors reviewed the medical charts (1999-2012) of 636 male athletes
from a Southeastern Conference Division I university, which included 323
football athletes and 313 nonfootball athletes. 
Data collected included blood pressure, body mass index, medication use,
and supplement use in the initial through final years of participation.  The authors excluded athletes if they had a
history of cardiac or renal abnormality or surgery, no preparticipation
physical evaluation records, or no initial blood pressure collected.  Blood pressure classifications from Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
(JNC-7) were used: 1) Normal
blood pressure = systolic below 120 mmHg and diastolic below 80 mmHg, 2) Prehypertension
= systolic of 120-139 mmHg or diastolic of 80-89 mmHg, and 3) hypertension =
systolic blood pressure > 140 mmHg, diastolic blood pressure >
90 mmHg, history of hypertension, or use of an antihypertensive medication.  The authors found that football players were
more likely to be black, have a higher initial body mass index, and parental
history of hypertension. Overall, 19% of football athletes had hypertension in
both their initial and final years of participation, which was higher than the
nonfootball athletes – 7% and 10%. The authors also found that 76% of all male
athletes had prehypertension or hypertension.

authors found similar results compared to previous smaller studies of hypertension
among college football athletes – 23.5% and 14%. The authors noted that a limitation to
their study is that they focused on one school, but if this data is accurate,
male college athletes may have an increased cardiovascular risk that should be
followed more closely.  This elevated
blood pressure could be due to multiple factors, such as the use of nonsteroidal
anti-inflammatory drugs (NSAIDs), high salt intake, strength and resistance
training, the pressure of competition, stimulant use, supplement use, increased
body mass index, or race.  The authors
also question whether the current guidelines of hypertension for the general
population can be applied to the athletes. 
Can the high blood pressure be explained by the football players having
a higher body mass index than nonfootball players, or is their body mass index overestimated
due to increased muscle mass? Once a high blood pressure reading is identified,
a follow-up plan should be made to repeat the blood pressure in several
weeks.  Ideally, this should be done when
all factors for an elevated reading are eliminated, such as the athlete having
just finished a workout or a caffeinated beverage, or using NSAIDs.  By educating athletes at a young age
regarding their cardiovascular health, hopefully this can carry over to their
adult years.  Further research may help
us define the significance of hypertension in a athletic population and how to optimally
manage it in the university setting.

Questions for
Discussion: What programs do you have at your university to monitor blood
pressure in your athletes?  What patient
education or advice do you provide to these athletes?

by: Kris Fayock, MD
Reviewed by: Jeffrey Driban


Karpinos AR, Roumie CL, Nian H, Diamond AB, & Rothman RL (2013). High prevalence of hypertension among collegiate football athletes. Circulation. Cardiovascular Quality and Outcomes, 6 (6), 716-23 PMID: 24221829