Chronic Pain Linked to Increased Risk for Incident Hypertension

Living with chronic pain may be an independent risk factor for the development of hypertension, new data suggest.

In the analysis of more than 200,000 patients in the UK Biobank, investigators found that those with chronic widespread pain had the greatest risk of developing hypertension over the 13.5-year follow-up period (HR 1.75; 95% CI 1.52-2.00). People with other types of pain, particularly chronic abdominal, headache, and neck pain, also were at significantly greater risk compared with those who had no chronic pain.

The authors, led by Pei Qin, PhD (University of Glasgow, Scotland), say gaining clarity on how various types and locations of pain affect blood pressure could help identify new mechanisms and targets to prevent and treat hypertension.

Qin and colleagues found that about 11% of the association between pain and hypertension was mediated by depression, suggesting that chronic pain may predispose some individuals to depression, which in turn may increase the risk for hypertension. They hypothesize that early detection and treatment of depression in people with chronic pain may turn out to be a worthwhile intervention for reducing the risk of developing high blood pressure.

“Furthermore, this study also found that [C-reactive protein] partially mediated the association between pain and hypertension, which suggests a potential role of inflammation,” Qin and colleagues write in the paper published online November 17, 2025, ahead of print in Hypertension. The portion of pain mediated by inflammation was small, at 0.4%.

Importantly, the authors note that both the depression and inflammation hypotheses are subject to confounding and should be interpreted with caution pending further studies, preferably randomized trials.

Commenting for TCTMD, Daniel W. Jones, MD (University of Mississippi School of Medicine, Jackson), who chaired the 2025 American Heart Association/American College of Cardiology high blood pressure guideline, said the findings, while interesting, are probably most relevant to researchers looking to pursue clinical trials that further narrow down the association between pain and hypertension.

“We've known for a long time that acute pain affects blood pressure, [but] it's a little bit harder to study chronic pain. This study is a good effort to try to understand it,” he said. “But there's not enough evidence here for clinicians to treat people with chronic pain and high blood pressure with antidepressants, thinking that it will be the solution for their high blood pressure; or with anti-inflammatory agents for that matter.”

Even Short-term Pain Raises Risk

For the study, Qin and colleagues analyzed data from 206,963 UK Biobank participants (mean age 54 years; 62% female) with and without self-reported chronic pain. Pain was categorized as short-term (pain at more than one body site in the past month but less than 3 months duration), chronic localized (pain at more than one body site of at least 3 months), or chronic widespread (pain all over the body for at least 3 months). Depression was measured with the Recent Depressive Symptoms (RDS-4) tool.

Across all three pain categories, the risk of hypertension was increased compared with individuals with no reported pain. Investigators noted a relationship between the number of chronic pain sites and hypertension, with a 7% increased risk per additional site increase in chronic pain.

After widespread pain, the highest risk of incident hypertension was associated with chronic pain:

• Abdominal (HR 1.43; 95% CI 1.20-1.71),
• Headache (HR 1.22; 95% CI 1.13-1.31)
• Neck (HR 1.19; 95% CI 1.11-1.28)
• Hip (HR 1.17; 95% CI 1.01-1.34)
• Back (HR 1.16; 95% CI 1.07-1.25)

Increased risks also were seen in those with short-term headache (HR 1.15; 95% CI 1.07-1.23) and short-term pain in the back (HR 1.24; 95% CI 1.12-1.37) and neck/shoulder (HR 1.15; 95% CI 1.04-1.28).

Pay attention to blood pressure and treat it with known antihypertensive agents as you're treating the chronic pain. Daniel W. Jones

Qin and colleagues point out that since the researchers measured pain only at baseline with no repeat measurements, the study’s ability to assess changes in or classify pain—particularly for those with short-term symptoms—is a limitation of the study. Furthermore, with a mean age of 54, the findings may not be relevant to the elderly.

In addition to those concerns, Jones noted that the study participants were primarily white individuals, making it critically important that further studies in this area use a more diverse representation of the chronic pain population.

“I think for now, the message to clinicians is to pay attention to blood pressure and treat it with known antihypertensive agents as you're treating the chronic pain,” Jones added.