Systolic and pulse pressure associate with incident knee osteoarthritis: data from the Osteoarthritis Initiative

Abstract

Objectives We evaluated the relationship of systolic blood pressure, diastolic blood pressure, pulse pressure, and treatment with antihypertensives with knee osteoarthritis incidence in a United States cohort. Methods We performed a longitudinal study (2004 – 2010) nested within the Osteoarthritis Initiative Study including only individuals without knee osteoarthritis at baseline. Systolic blood pressure, diastolic blood pressure and pulse pressure were assessed at baseline, 12-, 24-, and 36-month visits. Knee radiographs at baseline, 12-, 24-, 36- and 48 month visits defined radiographic osteoarthritis, Kellgren and Lawrence grade ≥ 2. We performed logistic regression, adjusting for age, sex, body mass index, NSAID use, number of antihypertensive medications, diabetic medications, and cholesterol medications. Results 1930 people (6040 observations) were included. Annual incidence rates of radiographic osteoarthritis by systolic blood pressure quartiles (lowest to highest) were 2.1%, 3.4%, 3.7%, and 3.7%. Fully adjusted odds ratios of incident radiographic OA for the 2nd–4th quartiles were 1.6, 1.7, and 1.6 relative to the lowest quartile (p for trend = 0.03). Pulse pressure results were similar. There was no association with diastolic blood pressure. Compared to those not taking any antihypertensive medications, those taking ≥ 3 had decreased odds (0.4, 0.1–1.0) of developing incident OA. Conclusions In a United States cohort, higher systolic blood pressure and pulse pressure are associated with increased incidence of radiographic knee osteoarthritis while treatment with ≥ 3 antihypertensive medications was associated with reduced incidence. These findings suggest a new and promising avenue for research on disease modification in knee osteoarthritis.

Systemic Inflammation and Endothelial Dysfunction—a Possible Link Between Osteoarthritis and Hypertension: Comment on the Article by Niu et al

“…Besides the use of nonsteroidal antiinflammatory drugs (NSAIDs), as the authors suggest, other mechanisms could be involved in this process. Thus, in a US cohort, higher BP was associated with increased incident radiographic knee OA after adjustment for several confounders, including NSAID use .…”

Setting up distinctive outcome measures for each osteoarthritis phenotype

“… 109 High systolic blood pressure and pulse pressure were associated with increased incidence of radiographic knee OA, while treatment with ⩾3 antihypertensive medications reduced it. 110 Moreover, the presence of hypertension and diabetes mellitus was associated with bone loss at subchondral plate in knee OA. 111 …”

High Blood Pressure and Osteoarthritis: Friends or Foes? Comment on the Article by Funck‐Brentano et al

“…Unlike other components of metabolic syndrome, this association remained statistically significant after adjustment for body mass index (BMI). In addition, pulse pressure, the difference between systolic BP and diastolic BP, has been associated with incident radiographic knee OA based on data from the Osteoarthritis Initiative (5). Therefore, it is worthwhile to explore the relationship between diastolic BP and a hospital diagnosis of OA, although radiographic OA versus symptomatic OA was not distinguished by Funck-Brentano and colleagues (3).…”

“…Third, systolic BP (rather than a hospital diagnosis of hypertension or the use of antihypertensive medication) was included as an exposure parameter in this Mendelian randomization (MR) analysis. The use of antihypertensive medication, especially taking more than 3 antihypertensive medications, has been reported to confer decreased odds of developing incident OA (5). Funck-Brentano and colleagues only excluded (but did not investigate) those who received antihypertensive medication for the sensitivity analysis in this MR study.…”