Chronic Pain Linked to Greater Risk of Hypertension, Depression Mediates the Relationship

Patients experiencing chronic pain face a substantially elevated risk of developing hypertension, with those suffering from chronic widespread pain showing a 75% increased risk compared to pain-free individuals, according to findings published today in Hypertension.

The research, which tracked more than 206,000 adults over a median 13.5 years, reveals that both the duration and distribution of pain correlate with hypertension development, and that depression mediates a significant portion of this association.

The UK Biobank cohort study, led Jill Pell, MD, CBE, the Henry Mechan Professor of Public Health at the University of Glasgow in the United Kingdom, found that 9.62% of participants (19,911 individuals) developed hypertension during follow-up. Compared with participants reporting no pain, those with short-term pain had a 10% greater risk (hazard ratio 1.10, 95% CI, 1.03–1.17) and those with chronic localized pain had a 20% great risk (HR 1.20, 95% CI, 1.14–1.26) of experiencing an increase in blood pressure. Pell and colleagues reported a clear dose-response relationship between the number of chronic pain sites and hypertension risk.

Location, Location, Location

Analysis by pain location demonstrated varying degrees of elevated risk, according to the study. Chronic widespread pain carried a 74% higher risk of developing hypertension, while chronic abdominal pain showed a 43% increased risk. Chronic headaches corresponded to a 22% higher risk, chronic neck/shoulder pain to 19%, chronic hip pain to 17%, and chronic back pain to 16%.

"The more widespread their pain, the higher their risk of developing high blood pressure," Pell said in a statement. "Part of the explanation for this finding was that having chronic pain made people more likely to have depression, and then having depression made people more likely to develop high blood pressure. This suggests that early detection and treatment of depression, among people with pain, may help to reduce their risk of developing high blood pressure."

The researchers performed a mediation analysis, which revealed that depression accounted for 11.3% of the association between chronic pain and hypertension, while inflammation as measured by C-reactive protein (CRP) contributed 0.4%, for a combined mediation effect of 11.7%. The findings indicate that while these factors explain some of the relationship, other mechanisms remain at play.

UK Biobank Cohort

The study population consisted of adults ages 40-69 at biobank enrollment between 2006 and 2010, with an average age of 54 years. Women comprised 61.7% of participants, and 96.7% self-identified as white adults. Among all participants, 35.2% reported experiencing chronic musculoskeletal pain, with 62.2% reporting chronic pain at one body site, 34.9% at 2-3 sites, and 3.2% at 4 sites.

Characteristics associated with participants who reported chronic pain included higher rates of unhealthy lifestyle factors, larger waist circumference, elevated body mass index, more comorbid conditions, and residence in areas with higher unemployment and lower socioeconomic indicators compared with pain-free participants. The researchers controlled for smoking status, alcohol consumption, physical activity, sedentary time, sleep duration, and dietary intake of fruits and vegetables.

"When providing care for people with pain, health care workers need to be aware that they are at higher risk of developing high blood pressure, either directly or via depression. Recognizing pain could help detect and treat these additional conditions early," Pell said.

RCTs Needed to Explore Pain Mangement Methods Further

"Chronic pain needs to be managed within the context of the patients' blood pressure, especially in consideration of the use of pain medication that may adversely affect blood pressure," observed Daniel W. Jones, MD, chair of the 2025 American Heart Association/American College of Cardiology High Blood Pressure Guideline and dean and professor emeritus of the University of Mississippi School of Medicine, in a statement. He pointed to the study's contribution to understanding the effect of chronic pain on blood pressure beyond just short term elevations. Jones, who was not involved in the research, pointed to the need for randomized controlled trials examining pain management approaches and blood pressure outcomes, particularly regarding nonsteroidal anti-inflammatory drugs such as ibuprofen, which may independently raise blood pressure.

Among the study's limitations the authors acknolwedge its focus on middle- and older-aged adults who were predominantly White and of British origin, a factor limiting generalizability to other populations. The analysis relied on self-reported pain levels, clinical diagnostic coding, a single pain assessment at baseline, and two blood pressure measurements. Depression assessment occurred through questionnaire responses addressing mood, interest level, restlessness, and lethargy over the preceding 2 weeks. Finally, follow-up concluded at the earliest of 3 events: hypertension diagnosis, participant death, or end of available follow-up records.

The findings underscore the clinical importance of blood pressure monitoring in patients with chronic pain and suggest that addressing depression in this population may reduce hypertension risk. The research adds to evidence supporting comprehensive pain management strategies that account for cardiovascular risk factors.