Hypertension Journal

Show Contents

Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Analysis of Hypertension as a Risk Factor
for Osteoarthritis Knee
1Ajai Singh, 2Narsingh Verma, 3Manish Yadav, 4Sabir Ali
1,2Professor, 3,4Research Scholar
1,3,4Department of Orthopedic Surgery, King George's MedicalUniversity, Lucknow, Uttar Pradesh, India
2Department of Physiology, King George's Medical UniversityLucknow, Uttar Pradesh, India
Corresponding Author: Ajai Singh, Professor, Departmentof Orthopedic Surgery, King George's Medical UniversityLucknow, Uttar Pradesh, India
Phone: +919415022557
e-mail: as29762@gmail.com
The basic objective of the recent analysis was to studyhypertension as a risk factor for osteoarthritis (OA) knee. Inthis study, totally 155 patients of OA knee, of age more than40 years, were enrolled for the study. The study was carriedout in the Department of Orthopedic Surgery, King George'sMedical University (KGMU), Lucknow, Uttar Pradesh, India.According to the diagnostic criteria of the American College ofRheumatology, the cases were taken into consideration. A briefhistory about the disease was taken, and complete examinationswere done. For the clinical severity, visual analog scale(VAS) and Lequesne index were done and for radiologicalseverity assessment, Kellgren-Lawrence (KL) grading andX-ray bilateral knee were done to observe the radiologicalchanges. Moreover, the blood pressure was measured consecutivelyin both arms for three times via auscultatory methodfollowing the American Heart Association guidelines, and theaverage was calculated and recorded. If the recorded averageis greater than 140/90 mm Hg, then the subject is labeled as"hypertensive." In this study, we found a significant associationbetween the severity of the OA knee and hypertension.The study is not only for our knowledge enrichment about theassociation of OA and hypertension, but also to fill the gaps withrelated information; it will reshape our knowledge toward themanagement of heart disease, hypertension, and OA. Also, wecan determine the new possible risk factors for these diseases.
Keywords: Hypertension, Metabolic syndrome, Obesity,Osteoarthritis, Osteoarthritis knee.
How to cite this article: Singh A, Verma N, Yadav M, Ali S.Analysis of Hypertension as a Risk Factor for OsteoarthritisKnee. Hypertens J 2017;3(4):167-170.
Source of support: Nil
Conflict of interest: None


Osteoarthritis is a very common cause of disabilityamong the elderly. This includes the loss of articularcartilage in the joints. High blood pressure and hypertension are now thought to cause an adverse effect on thejoints. Findlay1 in a study explained various reasons forthis association: first is that the blood vessels graduallybecome narrowed with time, second is the restriction ofblood flow to the bone that lies beneath the joint cartilagevia narrowed blood vessels, third is insufficient supply ofnutrients to cartilage and circulation of blood, and fourthis the deterioration of cartilage. One of the most importantrisk factors for OA is obesity.2-7 The basic objective of thisstudy was to investigate the correlation of hypertensionwith OA knee and its association with the clinicoradiologicalprofile of OA knee.

Totally, 155 cases of OA knee patients of both sexes(male and female) and of age >40 years were registered.However, secondary OA knee patients, thoseon immuno suppressants and drugs like anticanceragents, ATT etc., with articular malalignment, neuromuscularinvolvement, uncontrolled diabetes, thyroiddisorder, autoimmune diseases, and nonwillingpatients were excluded from our study. In the Departmentof Orthopedic Surgery, KGMU, Lucknow, UttarPradesh, India, the whole of the study was carriedout. The cases were taken into consideration as perthe American College of Rheumatology guidelines.A complete examination along with brief history wasdone. For clinical severity, VAS and Lequesne and forradiological severity assessment, K L grading and X-raybilateral knee were done, to observe the radiologicalchanges. Blood pressure was measured consecutivelyin both arms three times via auscultatory method followingthe American Heart Association guidelines andthe average was calculated and recorded.8 Mercurymanometer was used for measuring blood pressureand an average of greater than 140/90 mm Hg in anyside was labeled as "hypertensive."

Statistical Analysis

Statistical analysis was performed using StatisticalPackage for the Social Sciences software for Windowsprogram (15.0 version). The continuous variables wereevaluated with a mean (±standard deviation) or rangevalue when required. For comparison of the means between patient groups, Pearson likelihood ratio, chisquare,linear-by-linear association at 95% confidenceinterval were used. The p-values smaller than 0.05 or0.001 and were regarded as significant.

Hypertension Journal, October-December, Vol 3, 2017 167

Ajai Singh et al

Table 1: Baseline parameters
Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Graph 1: Mean blood pressure of hypertensive andnonhypertensive OA patients

Table 2: Association of clinical rigorousness of OA knee and hypertension
Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee


Totally, 155 patients (M/F = 1/1.38) were observed withthe mean age of 55.48 ± 4.92 years and with a familyhaving negative history of OA in 71.67% patients. Of the155 OA knee patients, totally 68 patients were recordedwith bilateral knee involvement, while 53 patients wererecorded with right knee involvement and 34 patientswere recorded with left knee involvement (R/L = 1.6). Themean body mass index (BMI) was 28.49 kg/m2 (Table 1).

Among the 155 OA knee patients, totally 97 (63%)patients were hypertensive and the rest were 58 (37%)normotensive patients with mean blood pressure of 156.4± 5.27 mm Hg (systolic blood pressure) and 96.7 ± 2.91mm Hg (diastolic blood pressure) and 122.4 ± 4.36 mm Hg(systolic blood pressure) and 77.3 ± 3.65 mm Hg (diastolicblood pressure) correspondingly (Graph 1).

We associated hypertension with the medical severity(VAS and Lequesne index) and radiological severity (KLgrading) of OA knee; we found a significant correlationbetween hypertension along with rigorousness of OA knee.

Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Graph 2: Association of clinical rigorousness (VAS) of OA knee andhypertension; NH: Nonhypertensive; H: Hypertensive; ***Significant(< 0.0001)

The mean VAS scores of normotensives and hypertensiveswere recorded as 8.4 ± 1.02 and 5.8 ± 1.27, respectively(Table 2 and Graph 2). There was a highly importantassociation among hypertensive OA knee patients andVAS scale (p < 0.0001).

In the Lequesne index, 44 patients were in the categoryof extremely severe, (≥14) out of which 42 patients werehypertensive, the mean score in normotensive patients and hypertensive being 16.2 ± 2.63 and 09.8 ± 2.09 respectively(Table 3 and Graph 3). There was a highly importantrelation among hypertensive OA knee patients and theLequesne Index (p < 0.0001).


Analysis of Hypertension as a Risk Factor for Osteoarthritis Knee

Table 3: Association of radiological rigorousness of OA kneewith hypertension
Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
BP: Blood pressure

According to the radiological rigorousness in the KLgrading scale, 47 patients were recorded with grade III,out of which 38 patients had hypertension (Table 3and Graph 4). There was a highly significant associationamong hypertensive OA knee patients and KL gradingscale (p < 0.0001).

Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Graph 3: Association of radiological severity of OA knee withhypertension; NH: Nonhypertensive; H: Hypertensive; ***Significant(< 0.0001)

Analysis of Hypertension as a Risk Factorfor Osteoarthritis Knee
Graph 4: Association of clinical severity (Lequesne index) of OAknee and hypertension; NH: Nonhypertensive; H: Hypertensive; ***Significant (< 0.0001)(< 0.0001)


The OA causes pain and loss of functional ability frequently.9 Hypertension and high blood pressure lead toadverse effects of OA because, in these cases, the bloodvessels become narrowed and result in restricted bloodflow to the site. Hence, blood and nutritional supply to thecartilage get deprived that further leads to the beginningof cartilage destruction. If the problems are left unattendedlong enough, it may lead to OA.10-14 In the presentstudy, we aimed to study the correlation of hypertensionas a risk factor for OA knee and its association with theclinicoradiological profile.

According to Lohmander et al,11 the increasingpopulation and obesity were directly proportional toincidences of OA, which will consistently rise over thecoming decades. People with obesity, accidents, andphysically challenged profile have the risk of OA, especiallyat the level of hand, knee, and hip. In another study,Dahaghin et al12 found that in 3,585 patients with OA ofhand, overweight patients with OA of hand was commonestOA and when compared with relative patients ofyounger age it was found true. As per Singh et al,15 theOA commonly coexists with hypertension in the samepatient. In the NHANES III (3rd National Health andNutrition Examination Survey), statistics demonstratedthat OA is diagnosed in around 21% of the 115.9 millionUS adults when they were aged 35 years and with OA.15 Infact, NHANES III expected that a diagnosis of hypertensionis present in 40% of these treated subjects.13-15 A studyby Kozochina and Bagirova16 in 1,350 patients with OAfound that 82% patients had metabolic syndrome. Theyconcluded that an important correlation exists betweenOA and metabolic syndrome.

We also found a significant relationship betweenhypertension and severity of OA knee like in previoussimilar studies.10,12,15,16 This means that paying attentionto weight, blood pressure, and blood glucose is importantto prevent the development and persistence of OA. Singlecenter study with a small sample size was the limitationof the present study.


The study is not only for our knowledge enrichmentabout the association of hypertension and OA, but alsoto fill the gaps with related information; it will reshapeour knowledge toward the management of heart disease,hypertension, and OA. We can also determine the newpossible risk factors for these diseases.

  1. Findlay DM. Vascular pathology and osteoarthritis. Rheumatology(Oxford) 2007 Dec;46(12):1763-1768.

Hypertension Journal, October-December, Vol 3, 2017 169

Ajai Singh et al

  1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K,Christy W, Cooke TD, Greenwald R, Hochberg M, et al.Development of criteria for the classification and reportingof osteoarthritis. Classification of osteoarthritis of theknee. Diagnostic and Therapeutic Criteria Committee of theAmerican Rheumatism Association. Arthritis Rheum 1986Aug;29(8):1039-1049.
  2. Kafil N, Aamir K, Murad S, Ara J, Anjum S. A placebo controlledclinical trial on nimesulide in osteoarthritis. J SurgPakistan 2003 Jun;8:5-8.
  3. Ker RG, AlKawan RH. A primary care approach for physiciansin 2000 and beyond. Saudi Med J 2001 May;22(5):403-406.
  4. Wigley RD, Zhang NZ, Zeng QY, Shi CS, Hu DW, CouchmanK, Duff IF, Bennett PH. Rheumatic diseases in China:ILAR-China study comparing the prevalence of rheumaticsymptoms in northern and southern rural populations.J Rheumatol 1994 Aug;21(8):1484-1490.
  5. Chopra AM, Patil J, Billampelly V, Relwani J, Tandale HS.The Bhigwan (India) COPCORD: methodology and firstinformation report. APLAR J Rheumatol 1997;1:145-154.
  6. Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F,Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR,et al. Prevalence of rheumatic diseases and associated outcomesin rural and urban communities in Bangladesh: aCOPCORD study. J Rheumatol 2005 Feb;32(2):348-353.
  7. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J,Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendationsfor blood pressure measurement in humans and experimental animals. Part 1: blood pressure measurementin humans. A statement for professionals from the Subcommitteeof Professional and Public Education of the AmericanHeart Association Council on High Blood Pressure Research.Hypertension 2005;45:142-161.

  1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions.Bull World Health Organ 2003 Nov;81(9):646-656.
  2. Wang C, Jiang Q. Study on the relationship between osteoarthritisand hypertension. Medical Recapitulate 2011;23:023.
  3. Lohmander LS, Englund PM, Dahl LL, Roos EM. The longtermconsequence of anterior cruciate ligament and meniscusinjuries: osteoarthritis. Am J Sports Med 2007 Oct;35(10):1756-1769.
  4. Dahaghin S, Beirman-Zeinstra SM, Koes, BW, Hazes JM, Pols HA.Do metabolic factors add to the effect of overweight on handosteoarthritis. Ann Rheum Dis 2007 Jul;66(7):916-920.
  5. Rabenda V, Manette C, Lemmens R, Mariani AM, Struvay N,Reginster JY. Direct and indirect costs attributable to osteoarthritisin active subjects. J Rheumatol 2006 Jun;33(6):1152-1158.
  6. Gabriel SE, Crowson CS, Campion ME, O'Fallon WM. Directmedical costs unique to people with arthritis. J Rheumatol1997 Apr;24(4):719-725.
  7. Singh G, Miller JD, Lee FH, Pettitt D, Russell MW. Prevalenceof cardiovascular disease risk factors among US adults withself-reported osteoarthritis: data from the Third NationalHealth and Nutrition Examination Survey. Am J Manag Care2002 Oct;8(15 Suppl):S383-S391.
  8. Kozochina IE, Bagirova GG. Metabolic syndrome and acourse of osteoarthritis. Ter Arkh 2007;79(10):13-20.