This study examined associations of concomitant hypertension and elevated body mass index (BMI) with persistence of concussion symptoms.

Most patients with concussion experience symptom resolution within weeks after injury. However, approximately one-third of patients’ symptoms last for months or longer. Identifying risk factors for prolonged concussion symptoms is clinically meaningful for evaluating at-risk patients and for developing treatments.

This study included a retrospective review of medical records from the NYU Langone Health Concussion Center between 2013-2022. Patients included had no prior history of concussion and received care within one year of injury. Captured variables included blood pressure and BMI at initial visit, existing hypertension diagnosis, number of visits, number of days between injury and final visit, and diagnosis of post-concussion syndrome (PCS).

Of 422 patients, the mean age was 41 (SD=16.7), 65% were female, 60% reported white race, and 65% reported non-Hispanic or Latino ethnicity. Patients with hypertension had a greater mean duration from injury to last appointment compared with non-hypertensive patients (465 vs. 240 days, p<0.0001, Wilcoxon Rank-Sum Test). The same pattern was observed for patients with elevated BMI compared to those without (388 vs. 259 days, p=0.002). Hypertension and elevated BMI were associated with greater numbers of visits (4.5 vs. 2.5 visits for hypertensive vs. non-hypertensive, p<0.0001; 3.8 vs. 2.7 visits for patients with vs. without elevated BMI, p=0.003). The probability of receiving a PCS diagnosis was increased for hypertensive patients (35% vs. 17%, p<0.001) and patients with elevated BMI (29% vs. 19%, p=0.021). When accounting simultaneously for injury mechanism, race, ethnicity, age, and sex, all reported associations for hypertension remained statistically significant.

Hypertension may be a risk factor for greater symptom duration and continued referrals following concussion. Further investigation is needed to determine whether treatment of hypertension prior to or following injury could improve concussion-related outcomes.