Shoulder
The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes

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Background

This study was conducted to establish whether hypertension increases the risk of occurrence of rotator cuff tear and influences its size.

Materials and methods

A case-control design was used. We studied 408 consecutive patients (228 men, 180 women) who underwent arthroscopic rotator cuff repair. Tear size was determined during surgery. The control group included 201 individuals. For the study purpose, participants were divided into 2 groups by presence or absence of hypertension. We applied a logistic regression model to investigate if hypertension affects the risk of cuff tear. A multinomial logistic regression model was applied to explore the association between hypertension and tear size. We used the analysis of covariance method to determine if the duration of hypertension influences the severity of the tear; finally, we compared mean duration of antihypertensive therapy in patients with small, large, and massive tears. All analyses were adjusted for age and sex.

Results

Hypertension was associated with a 2-fold higher risk of tear occurrence (odds ratio [OR], 2.05; 95% confidence interval [CI], 41-2.98). No association was detected between hypertension and the probability of a small tear (OR, 0.63, 95% CI, 0.33-1.19). Hypertensive individuals were 2 times more likely to experience large tear (OR, 02.09; 95% CI, 1.39-3.16) and 4 times more likely to experience massive tear (OR, 04.30; 95% CI, 2.44-7.58) than normotensive individuals. Mean duration of antihypertensive therapy significantly increased from small tear (1.08 years) to large tear (3.20 years) to massive tear (6.34 years) patients (analysis of covariance: F(2,403) = 16.357, P = 1.48 × 10−7).

Conclusions

Our data provide evidence that hypertension is a significant risk factor for the occurrence and severity of rotator cuff tears.

Section snippets

Materials and methods

This study used a case–control design. The cases were 408 consecutive patients who underwent arthroscopic repair of a rotator cuff tear between January 2009 and May 2010 and were treated by two of the authors (S.G., V.C.). The control group included 201 individuals who underwent orthopedic examination because of pathologies not affecting the shoulder. For the purposes of this study, participants were divided into two groups depending on the presence or absence of hypertension. Participants were

Results

Sample characteristics are reported in Table II. Patients with a massive tear were slightly older than the control participants and also older than patients with a small or a large tear; therefore, age was included as a covariate in the subsequent statistical analyses. The proportions of men and women were similar in the control group and in each patient category. Adjusting for age and sex, the risk of tear occurrence was twice as high in hypertensive individuals as in normotensive participants

Discussion

Multicenter studies in different countries have published data about the higher risk of cardiac disease and stroke in patients affected by hypertension21; unfortunately, the possible degenerative effects of hypertension on osteotendinous junctions still have to be brought to light.

The genesis of rotator cuff rupture is multifactorial. Intrinsic factors, such as rotator cuff hypovascularity,11 have been taken into consideration. Arterial hypertension is a cause of peripheral hypovascularity;

Conclusion

Our study shows that arterial hypertension is more frequent in patients with rotator cuff tear than in controls and that patients with hypertension are more likely to develop a large or massive cuff tear. It also shows how a longer duration of antihypertensive therapy, interpreted as duration of disease, is correlated with an increased severity of tear.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (21)

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Italian law does not require Investigational Review Board approval for this type of study. The authors certify that their respective institutions approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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