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

We evaluated the relationship of systolic blood pressure, diastolic blood pressure, pulse pressure, and treatment with antihypertensives with knee osteoarthritis incidence in a US cohort. 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. One thousand nine hundred and thirty 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 osteoarthritis (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. In a US 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.