Chronic Pain Linked to Elevated Risk of High Blood Pressure
Persistent pain in adults seems to significantly contribute to the development of hypertension, with the duration of the pain and its specific locations playing crucial roles in this association. Notably, depression and inflammation partially account for this relationship. Experts emphasize that proper pain control is essential for preventing and managing high blood pressure, which remains a primary contributor to cardiovascular conditions and mortality worldwide.
Recent research published on November 17 in Hypertension, a publication from the American Heart Association, reveals that chronic pain increases the odds of hypertension in adults. Key influencing elements include the pain’s anatomical distribution, its extent across the body, and the presence of co-occurring depression.
By analyzing health data from over 200,000 U.S. adults, scientists discovered that those suffering from pain spread throughout multiple body areas faced substantially elevated risks of hypertension compared to individuals with no pain, transient aches, or localized chronic discomfort.
“The broader the distribution of their pain, the greater the elevated risk for hypertension,” explained lead investigator Jill Pell, M.D., C.B.E., Henry Mechan Professor of Public Health at the University of Glasgow in the United Kingdom. “A portion of this link stems from chronic pain increasing the likelihood of depression, which in turn heightens the chances of developing high blood pressure. Therefore, promptly identifying and addressing depression in pain sufferers could potentially lower their hypertension risk.”
Understanding Hypertension and Its Serious Health Implications
Hypertension, or high blood pressure, arises when blood exerts excessive force against arterial walls, thereby heightening the potential for heart attacks and strokes. In the United States, nearly half of all adults grapple with elevated blood pressure, encompassing stage one and stage two hypertension (readings from 130/80 mm Hg up to 140/90 mm Hg or beyond). This condition ranks as the top cause of preventable deaths both domestically and globally, as outlined in the 2025 joint guideline from the American Heart Association and American College of Cardiology, supported by eleven additional professional bodies.
Prior investigations have identified chronic musculoskeletal pain—defined as discomfort in areas like the hips, knees, back, or neck/shoulders persisting for three months or longer—as the predominant type of enduring pain among the general populace. The current study delves into the relationships between the occurrence, nature, and bodily spread of such pain and the subsequent onset of hypertension.
While inflammation and depression are established risk factors for high blood pressure, previous work had not quantified their roles in bridging chronic pain to future hypertension, a gap that this research addresses, according to Pell.
Methods for Gathering and Assessing Pain Information
Study participants filled out an initial survey detailing any pain from the prior month that disrupted their routine activities. They specified locations such as the head, face, neck/shoulder region, back, stomach/abdomen, hips, knees, or pain affecting the whole body. Individuals noting pain also reported if it had lasted over three months.
Depression screening involved a survey on symptoms like low mood, lack of interest, agitation, or fatigue experienced in the preceding two weeks. Levels of inflammation were gauged via blood analysis for C-reactive protein (CRP).
Primary Results from Extended Observation Period
Following a mean follow-up of 13.5 years, the investigation yielded several key insights:
- Approximately 10% of participants were diagnosed with high blood pressure during the study.
- Individuals with chronic widespread pain exhibited the highest risk elevation—a 75% increase—relative to pain-free participants. Short-term pain correlated with a 10% rise, and chronic pain confined to one area linked to a 20% increase.
- By pain site, chronic widespread pain showed a 74% heightened risk; chronic abdominal pain a 43% increase; chronic headaches a 22% rise; chronic neck/shoulder pain a 19% increase; chronic hip pain a 17% elevation; and chronic back pain a 16% higher risk.
- Depression, affecting 11.3% of the cohort, and inflammation, present in 0.4%, mediated 11.7% of the association between chronic pain and hypertension.
“Healthcare providers treating patients with ongoing pain should recognize their increased vulnerability to hypertension, whether directly or through depression,” Pell advised. “Identifying pain early can facilitate timely intervention for these related health issues.”
Insights from Experts on Pain, Inflammation, and Blood Pressure
Daniel W. Jones, M.D., FAHA, who chaired the 2025 American Heart Association/American College of Cardiology High Blood Pressure Guideline and serves as dean and professor emeritus at the University of Mississippi School of Medicine in Jackson, Mississippi, commented, “Acute pain is known to temporarily elevate blood pressure, but the long-term impacts of chronic pain have been less clear. This research clarifies a connection between the extent of chronic pain sites and hypertension, potentially driven by inflammation and depression.”
Jones, not affiliated with the study, called for randomized controlled trials to assess various pain relief approaches on blood pressure outcomes. He stressed the need to examine how medications like nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, might influence blood pressure levels.
“Managing chronic pain must consider patients’ blood pressure status, particularly when using analgesics that could negatively impact it,” Jones added.
Limitations of the Research and Demographics
The investigators acknowledged that the sample primarily comprised middle-aged and older white adults of British descent, limiting generalizability to other ethnicities, races, or younger demographics. Pain was self-reported, with reliance on a solitary assessment, clinical coding for diagnoses, and dual blood pressure readings.
Detailed Study Design and Methodology
This analysis drew from the UK Biobank, a comprehensive population study enrolling over 500,000 individuals aged 40-69 from 2006 to 2010 across England, Scotland, and Wales.
- The subset included 206,963 adults with an average age of 54 years; 61.7% were female, and 96.7% were white.
- Among participants, 35.2% had chronic musculoskeletal pain overall; 62.2% experienced it at one site; 34.9% at two to three sites; and 3.2% at four or more sites.
- Pain reporters, versus those without, tended to be female more often, exhibit less healthy behaviors, have greater waist sizes, elevated BMI, more chronic conditions, and reside in deprived areas marked by higher unemployment, reduced property ownership, and overcrowding.
- Adjustments were made for shared confounders like smoking, alcohol use, exercise, sedentary hours, sleep length, and intake of fruits and vegetables.
- Data collection involved touch-screen questionnaires, interviews, anthropometric measures (height, weight, BMI, waist, blood pressure), and blood assays for cholesterol and glycemic control (hemoglobin A1c).
- Hypertension diagnoses were ascertained from hospital records via ICD-10 codes.
- Follow-up spanned from baseline to the first occurrence of hypertension diagnosis, death, or data cutoff, defining each participant’s observation endpoint.
