Are adults with chronic pain more likely to develop hypertension than adults without chronic pain? A systematic review and meta-analysis

An association between persistent pain and blood pressure is increasingly recognised but is not fully understood. In this systematic review, we aimed to establish whether chronic pain (CP) is associated with a diagnosis of hypertension (HTN). After prospective registration (PROSPERO ID: CRD42025629486), we searched six databases from inception until January 8, 2025, for studies investigating the association between CP and HTN. Title and abstract screening, full-text review, data extraction, and risk of bias assessment were performed by two independent reviewers. Study quality assessment used the Risk of Bias In Non-randomised Studies of Exposures (ROBINS-E) tool. Meta-analysis was conducted using a random effects model. From 7973 records, we identified 23 eligible studies for inclusion, of which 20 provided suitable data for meta-analysis (total participants n=1 594 264). The pooled odds ratio for HTN in people with CP compared with controls was 1.66 (95% confidence interval [CI] 1.28-2.15) with high inter-study heterogeneity (I2=99.8%, Cochran Q=10 132, p<0.001). For specific pain conditions, the pooled odds ratio for HTN was 1.38 (95% CI 1.20-1.58, n = 374 234, heterogeneity: I2=65.1%, Cochran Q=14.34, p=0.014) in people with chronic, widespread pain, and 1.56 (95% CI 1.37-1.79, n=477 681, heterogeneity: I2=0%, Cochran Q=0.17, p=0.92) in people with chronic headache. There was no association between HTN and musculoskeletal pain, lower back pain, or gender. In line with a growing body of evidence in this field, this systematic review and meta-analysis confirms an association between chest pain and hypertension. Further research is warranted to understand this association and elucidate any mediating factors. PROSPERO (CRD42025629486).