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

Harriet E Taylor; Joseph C. Salf; Charlotte R. Roper-Marchand; Dhaneesha N. S. Senaratne; Blair H. Smith; Lesley A. Colvin; Jacob George

doi:10.1016/j.bja.2025.06.006

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

Harriet E Taylor
, Joseph C. Salf
, Charlotte R. Roper-Marchand
, Dhaneesha N. S. Senaratne
, Blair H. Smith
, Lesley A. Colvin (Lead / Corresponding author)
, Jacob George

Research output: Contribution to journal › Review article › peer-review

5 Citations (Scopus)

28 Downloads (Pure)

Abstract

Background: An association between persistent pain and blood pressure is increasingly recognised but is not fully understood. This systematic review aimed to establish whether chronic pain (CP) is associated with a diagnosis of hypertension (HTN).

Methods: After prospective registration (PROSPERO ID: CRD42025629486), we searched six databases from inception until 8 January 2025 for studies investigating the association between CP and HTN. Title/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. Metaanalysis was carried out using the random effects model.

Results: From 7,973 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 to controls was 1.66 (95% CI 1.28-2.15) with high inter-study heterogeneity (I 2=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 of HTN with musculoskeletal pain, lower back pain, or according to gender.

Conclusions: In line with a growing body of evidence in this field, this systematic review and meta-analysis confirms an association between CP and HTN. Further research is warranted to understand this association and elucidate any mediating factors.

Original language	English
Pages (from-to)	685-696
Journal	British Journal of Anaesthesia
Volume	135
Issue number	3
Early online date	9 Jul 2025
DOIs	https://doi.org/10.1016/j.bja.2025.06.006
Publication status	Published - Sept 2025

Keywords

back pain
chronic headache
chronic pain
fibromyalgia
hypertension

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

Access to Document

10.1016/j.bja.2025.06.006Licence: CC BY

Final published version
© 2025 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)
Final published version, 1.11 MBLicence: CC BY

Cite this

@article{d99f1ded982941158dcabad7585cb2e8,

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

abstract = "Background: An association between persistent pain and blood pressure is increasingly recognised but is not fully understood. This systematic review aimed to establish whether chronic pain (CP) is associated with a diagnosis of hypertension (HTN). Methods: After prospective registration (PROSPERO ID: CRD42025629486), we searched six databases from inception until 8 January 2025 for studies investigating the association between CP and HTN. Title/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. Metaanalysis was carried out using the random effects model. Results: From 7,973 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 to controls was 1.66 (95\% CI 1.28-2.15) with high inter-study heterogeneity (I 2=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 of HTN with musculoskeletal pain, lower back pain, or according to gender. Conclusions: In line with a growing body of evidence in this field, this systematic review and meta-analysis confirms an association between CP and HTN. Further research is warranted to understand this association and elucidate any mediating factors. ",

keywords = "back pain, chronic headache, chronic pain, fibromyalgia, hypertension",

author = "Taylor, \{Harriet E\} and Salf, \{Joseph C.\} and Roper-Marchand, \{Charlotte R.\} and Senaratne, \{Dhaneesha N. S.\} and Smith, \{Blair H.\} and Colvin, \{Lesley A.\} and Jacob George",

year = "2025",

month = sep,

doi = "10.1016/j.bja.2025.06.006",

language = "English",

volume = "135",

pages = "685--696",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - Are adults with chronic pain more likely to develop hypertension than adults without chronic pain?

T2 - A systematic review and meta-analysis

AU - Taylor, Harriet E

AU - Salf, Joseph C.

AU - Roper-Marchand, Charlotte R.

AU - Senaratne, Dhaneesha N. S.

AU - Smith, Blair H.

AU - Colvin, Lesley A.

AU - George, Jacob

PY - 2025/9

Y1 - 2025/9

N2 - Background: An association between persistent pain and blood pressure is increasingly recognised but is not fully understood. This systematic review aimed to establish whether chronic pain (CP) is associated with a diagnosis of hypertension (HTN). Methods: After prospective registration (PROSPERO ID: CRD42025629486), we searched six databases from inception until 8 January 2025 for studies investigating the association between CP and HTN. Title/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. Metaanalysis was carried out using the random effects model. Results: From 7,973 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 to controls was 1.66 (95% CI 1.28-2.15) with high inter-study heterogeneity (I 2=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 of HTN with musculoskeletal pain, lower back pain, or according to gender. Conclusions: In line with a growing body of evidence in this field, this systematic review and meta-analysis confirms an association between CP and HTN. Further research is warranted to understand this association and elucidate any mediating factors.

AB - Background: An association between persistent pain and blood pressure is increasingly recognised but is not fully understood. This systematic review aimed to establish whether chronic pain (CP) is associated with a diagnosis of hypertension (HTN). Methods: After prospective registration (PROSPERO ID: CRD42025629486), we searched six databases from inception until 8 January 2025 for studies investigating the association between CP and HTN. Title/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. Metaanalysis was carried out using the random effects model. Results: From 7,973 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 to controls was 1.66 (95% CI 1.28-2.15) with high inter-study heterogeneity (I 2=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 of HTN with musculoskeletal pain, lower back pain, or according to gender. Conclusions: In line with a growing body of evidence in this field, this systematic review and meta-analysis confirms an association between CP and HTN. Further research is warranted to understand this association and elucidate any mediating factors.

KW - back pain

KW - chronic headache

KW - chronic pain

KW - fibromyalgia

KW - hypertension

UR - https://www.scopus.com/pages/publications/105010010323

U2 - 10.1016/j.bja.2025.06.006

DO - 10.1016/j.bja.2025.06.006

M3 - Review article

C2 - 40640044

SN - 0007-0912

VL - 135

SP - 685

EP - 696

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 3

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Partnership for Assessment and Investigation of Neuropathic Pain: Studies Tracking Outcomes, Risks and Mechanisms (PAINSTORM) - (Joint with Universities of Oxford, Ghent and Aberdeen, Imperial College London and King's College London) (Advanced Pain Discovery Platform)

Consortium Against Pain InEquality (CAPE) - The Impact of Adverse Childhood Experiences on Chronic Pain and Responses to Treatment (Joint with University of Aberdeen, University of Edinburgh, University of Stirling and University College, London) (Advanced Pain Discovery Platform)

Adverse Childhood Experiences: Understanding the Impact on Multimorbidity in Adulthood, a Focus on Chronic Pain, Addiction and Mental Health (Wellcome Trust Clinical PhD Fellowship)

Cite this

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Projects

Partnership for Assessment and Investigation of Neuropathic Pain: Studies Tracking Outcomes, Risks and Mechanisms (PAINSTORM) - (Joint with Universities of Oxford, Ghent and Aberdeen, Imperial College London and King's College London) (Advanced Pain Discovery Platform)

Consortium Against Pain InEquality (CAPE) - The Impact of Adverse Childhood Experiences on Chronic Pain and Responses to Treatment (Joint with University of Aberdeen, University of Edinburgh, University of Stirling and University College, London) (Advanced Pain Discovery Platform)

Adverse Childhood Experiences: Understanding the Impact on Multimorbidity in Adulthood, a Focus on Chronic Pain, Addiction and Mental Health (Wellcome Trust Clinical PhD Fellowship)

Cite this