Asian Spine J.  2019 Dec;13(6):895-903. 10.31616/asj.2018.0308.

Hypertension Is Related to Positive Global Sagittal Alignment: A Cross-Sectional Cohort Study

• Arima H
• Togawa D
• Hasegawa T
• Yamato Y
• Yoshida G
• Kobayashi
• Yasuda T
• Banno T
• Oe S
• Mihara Y
• Ushirozako H
• Hoshino H
• Matsuyama

• KMID: 2467419
• DOI: http://doi.org/10.31616/asj.2018.0308

Abstract

STUDY DESIGN: Cross-sectional cohort study. PURPOSE: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals. OVERVIEW OF LITERATURE: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment.
METHODS
In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50-92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50-64 years, 65-74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup.
RESULTS
In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50-64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65-74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015).
CONCLUSIONS
This study showed that hypertension was associated with forward-shifted global sagittal alignment.

Keyword

Adult spinal deformity; Spino-pelvic parameters; Elderly volunteer; Sagittal vertical axis; Hypertension

MeSH Terms

Aged
Animals
Cohort Studies*
Female
Humans
Hypertension*
Incidence
Japan
Kyphosis
Lordosis
Male
Mass Screening
Microcirculation
Multivariate Analysis
Muscle, Skeletal
Quality of Life
Spine