Hypertension is associated with knee osteoarthritis pain in an age-dependent manner

Objective: Osteoarthritis (OA) is a painful and prevalent disease among older adults. Hypertension, commonly comorbid with OA and associated with aging, may influence OA pathology and pain. We hypothesized that hypertension would influence pain outcomes in an age-dependent manner and associate with greater radiographic OA severity among middle-aged and older adults. Methods: Cross-sectional analysis of 253 adults aged 45–85 years with or without knee pain was performed. Hypertension was defined by self-reported diagnosis or use of antihypertensive medications. Radiographic knee OA was assessed using Kellgren-Lawrence (KL) grades (none/early-stage OA: KL 0–2; late-stage OA: KL 3–4). Pain outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and movement-evoked pain following the Short Physical Performance Battery (SPPB). Results: Females with hypertension had greater odds of late-stage radiographic knee OA (KL grade > 2) than normotensive females (AOR = 3.70, 95 % CI = 1.63–8.37; p = 0.002); this was not observed in males. Hypertension was associated with age-dependent decline in WOMAC total scores (β = −1.018, p < 0.001) and movement-evoked pain (balance: β = −0.881, p = 0.001; walking: β = −1.017, p = 0.001), with no change in normotensive individuals. However, hypertensive individuals had greater odds of poor physical performance than normotensive individuals (AOR: 1.96, 95 % CI: 1.08–3.70; p = 0.029). Conclusions: Hypertension was associated with an age-dependent decline in reported knee pain, poorer physical function, and more severe radiographic knee OA in females. These findings suggest hypertensive individuals may deviate from a progressive OA pain trajectory and contribute to discordance between joint damage and pain.