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Asian Spine J. 2019 Jul 9:895-903. doi: 10.31616/asj.2018.0308. [Epub ahead of print]

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

Author information

Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.


Study Design:

Cross-sectional cohort study.


This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals.

Overview of the 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.


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.


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).


This study showed that hypertension was associated with forward-shifted global sagittal alignment.


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

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