BACKGROUND: The aim of our study was to establish if hypertension may increase the risk of occurrence of rotator cuff tear and influence the size. METHODS: We studied 408 consecutive patients (228 M, 180 F) mean aged 59 y.o. (range:47-68) who underwent arthroscopic treatment for a rotator cuff tear. Dimension of the tear was determined in each patient at the time of operative intervention. For analysis, patients were placed in one of the two groups based on presence or absence of hypertension. We applied a logistic regression model to investigate if hypertension affects the risk of occurrence of a tear. Then, we fitted a multinomial logistic regression model to explore the association between hypertension and each type of tear. Furthermore, we used the ANCOVA method to determine if duration of hypertension influences the severity of tear; finally, we compared mean duration of anti-hypertensive therapy across small, large and massive tear patients. All analyses were adjusted for age and gender. RESULTS: The hypertension was associated with a two-fold higher risk of tear occurrence (OR=2.05,95%CI:1.41-2.98). While no association was detected between hypertension and the probability of a small tear (OR=0.63, 95%CI: 0.33-1.19), hypertensive subjects were twice more likely to experience a large tear (OR=2.09,95%CI:1.39-3.16) and four times more likely to experience a massive tear (OR=4.30,95%CI:2.44-7.58) compared to normotensive subjects. Mean duration of anti-hypertensive therapy significantly increased from small tear (1.08 years) to large tear (3.20 years) to massive tear (6.34 years) patients (ANCOVA:F(2,403)=16.357, p=1.48×10-7). CONCLUSION: The hypertension is more prevalent in patients with at least a large rotator cuff tears. We found a significantly higher mean duration of therapy for those having a more severe tear. Our data provide evidence that hypertension is a significant risk factor for the occurrence and severity of rotator cuff.