Chronic Pain Greatly Increases High Blood Pressure Risk

Research Highlights:

• Chronic pain may play a significant role in increasing the risk of developing high blood pressure.
• How long the pain lasts and where it occurs both affect this risk, and part of the connection is linked to depression and inflammation.
• Researchers say the results emphasize how important strong pain management strategies are for preventing and controlling high blood pressure, a leading driver of cardiovascular disease and death.

Chronic Pain Connected to Higher Blood Pressure Risk

New findings published in Hypertension, an American Heart Association journal, suggest that adults living with chronic pain may face a greater chance of developing high blood pressure. The research indicates that where the pain occurs, how widespread it is, and whether a person also experiences depression all contribute to this increased risk.

More than 200,000 adults in the U.S. were included in the analysis. Those who reported chronic pain affecting many areas of the body were more likely to develop high blood pressure than people reporting no pain, short-lasting pain or pain confined to one part of the body.

“The more widespread their pain, the higher their risk of developing high blood pressure,” said lead study author Jill Pell, M.D., C.B.E., the Henry Mechan Professor of Public Health at the University of Glasgow in the United Kingdom. “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.”

What High Blood Pressure Means for Health

High blood pressure and hypertension occur when blood pushes too forcefully against vessel walls. This can raise the likelihood of a heart attack or stroke. According to the 2025 joint American Heart Association/American College of Cardiology guideline endorsed by 11 organizations, high blood pressure and stage one or stage two hypertension (130/80 mm Hg to 140/90 mm Hg or higher) affect nearly half of adults in the U.S. and remain the leading cause of death both nationally and globally.

Previous research has shown that chronic musculoskeletal pain — pain in the hip, knee, back or neck/shoulder lasting at least three months — is the most common form of chronic pain. The current study explored how the type and distribution of this pain throughout the body relate to the development of high blood pressure.

Inflammation and depression are known contributors to high blood pressure. However, Pell noted that earlier studies had not examined how much these factors may explain the pathway between long-term pain and hypertension.

How Pain, Depression and Inflammation Were Measured

Participants began the study by completing a questionnaire describing whether pain had interfered with their usual activities in the past month. They indicated whether the discomfort was located in the head, face, neck/shoulder, back, stomach/abdomen, hip, knee or across the entire body. Those who experienced pain also reported whether it had lasted longer than three months.

Depression was assessed through questions about mood, loss of interest, restlessness or lethargy over the previous two weeks. Inflammation levels were recorded through blood tests measuring C-reactive protein (CRP).

What the Long-Term Data Revealed

After an average follow-up period of 13.5 years, the researchers observed several key patterns:

• Nearly 10% of participants developed high blood pressure.
• Compared with people reporting no pain, those with chronic widespread pain had a 75% higher risk of high blood pressure. Short-term pain was linked with a 10% higher risk, and chronic pain in a single area was associated with a 20% higher risk.
• Chronic, widespread pain was connected to a 74% higher risk of developing high blood pressure; chronic abdominal pain to a 43% higher risk; chronic headaches to a 22% higher risk; chronic neck/shoulder pain to a 19% higher risk; chronic hip pain to a 17% higher risk; and chronic back pain to a 16% higher risk.
• Depression (11.3% of participants) and inflammation (0.4% of participants) together accounted for 11.7% of the observed relationship between chronic pain and high blood pressure.

“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.

Expert Commentary and Future Directions

Daniel W. Jones, M.D., FAHA, 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 Jackson, Mississippi, said, “It is well known that experiencing pain can raise blood pressure in the short term, however, we have known less about how chronic pain affects blood pressure. This study adds to that understanding, finding a correlation between the number of chronic pain sites and that the association may be mediated by inflammation and depression.”

Jones, who was not part of the research team, encouraged further investigation through randomized controlled trials that test different approaches to pain treatment and blood pressure management. He also pointed out the importance of examining how Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) including ibuprofen may raise blood pressure.

“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,” said Jones.

Study Limitations

The researchers noted that most participants were middle- or older-aged white adults of British origin. As a result, the findings may not apply to people from other racial or ethnic backgrounds, different age groups or populations in other countries. Pain reports relied on participants’ own descriptions, and the analysis used clinical diagnostic coding, a single pain assessment, and two blood pressure readings.

How the Study Was Conducted

• Data came from the UK Biobank, a large population-based project that recruited more than 500,000 adults ages 40-69 between 2006 and 2010 in England, Scotland and Wales.
• This study examined 206,963 adults. The average age was 54 years; 61.7% were women and 96.7% were white adults.
• Among all participants, 35.2% reported chronic musculoskeletal pain; 62.2% reported chronic pain at one site; 34.9% reported chronic pain at two to three musculoskeletal sites; and 3.2% reported pain at four sites.
• Compared with participants without pain, those with pain were more likely to be women, have less healthy lifestyle habits, larger waist circumference, higher body mass index (BMI), more long-term health conditions and live in communities with higher unemployment, lower home and car ownership and more overcrowding.
• Researchers accounted for several factors known to influence both pain and blood pressure, including smoking status, alcohol use, physical activity, sedentary time, sleep duration and fruit and vegetable intake.
• Baseline data collection involved a touch-screen questionnaire, interview, physical measurements (height, weight, BMI, waist circumference, blood pressure) and blood samples for cholesterol and blood sugar (hemoglobin A1c).
• Hospital records were used to identify high blood pressure through the International Statistical Classification of Diseases and Related Problems and diagnostic codes (ICD-10 codes).
• The follow-up period ended at the earliest of the following events: a high blood pressure diagnosis, the participant’s death or the close of available follow-up records.

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