The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes Stefano Gumina, MD, PhD a , Valerio Arceri, MD a , Stefano Carbone, MD a, *, Paolo Albino, MD a , Daniele Passaretti, MD a , Vincenzo Campagna, MD b , Corrado Fagnani c , Franco Postacchini, MD, PhD a a Department of Orthopaedic and Traumatology, University of Rome ‘‘Sapienza,’’ Rome, Italy b Celio Military Hospital, Rome, Italy c Superior Institute of National Health, Rome, Italy 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 prob- ability 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) ¼ 16.357, P ¼ 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. Level of evidence: Level III, Cross Sectional Study, Epidemiology Study. Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Rotator cuff tear; hypertension; risk factors; cuff tear size; comorbidities 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. *Reprint requests: Dr Stefano Carbone, MD, Department of Orthopaedics and Traumatology, University of Rome ‘‘Sapienza,’’ Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address: stefcarbone@yahoo.it (S. Carbone). J Shoulder Elbow Surg (2013) 22, 229-232 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2012.05.023