Physical disability a risk factor for hypertension

Individuals with physical disability are predisposed to hypertension, new research suggests.

Analysis of large data from the UK Household Longitudinal Study showed that the risk of incident hypertension was 65 percent higher among participants with physical disability than among those without any (relative risk [RR], 1.65, 95 percent confidence interval [CI],1.39–1.97; p<0.001). [J Hum Hypertens 2025;39:709-715]

When the risk of hypertension was assessed according to the number of physical disabilities reported at baseline, the risk increase rose from 29 percent in the presence of one disability (RR, 1.29, 95 percent CI, 1.01–1.64; p=0.043) to 110 percent in the presence of two or more disabilities (RR, 2.10, 95 percent CI, 1.69–2.59; p<0.001). A significant linear dose-response relationship was observed, such that hypertension risk increased with the number of physical disabilities (RR per additional domain, 1.43, 95 percent CI, 1.29–1.59; p<0.001).

Looking at the type of physical disability, the highest risks were observed for impairments involving coordination or balance (RR, 2.12, 95 percent CI, 1.58–2.84), mobility (RR, 2.03, 95 percent CI, 1.66–2.48), and sight (RR, 1.80, 95 percent CI, 1.27–2.56; p<0.001 for all). Substantial risk elevations were also observed for other types such as lifting or carrying objects (RR, 1.77, 95 percent CI, 1.45–2.17), continence problems (RR, 1.77, 95 percent CI, 1.30–2.39), personal care limitations (RR = 1.74; 95% CI: 1.20–2.53), hearing difficulties (RR = 1.70; 95% CI: 1.17–2.49), and manual dexterity (RR = 1.52; 95% CI: 1.11–2.07)

“This study provides evidence that physical disability is an independent predictor of incident hypertension in a nationally representative UK adult population. Over a 4-year follow-up, adults with physical disabilities at baseline were significantly more likely to develop hypertension than those without disabilities, even after accounting for a wide range of confounders,” according to the investigators.

The results persisted in fully adjusted models, indicating that the observed associations could not be fully explained by differences in age, sex, education, ethnicity, smoking, residential context, or existing health conditions, they said.

Furthermore, the consistently elevated risk of hypertension across all disability types shows that it is not merely the presence of a particular diagnosis but the broader experience of functional impairment that increases susceptibility to hypertension, the investigators pointed out. This can be attributed to a combination of reduced physical activity and prolonged sedentary behaviour, high stress levels, underlying neurological or musculoskeletal factors, and barriers to healthcare access. [Int J Environ Res Public Health 2021;18:6342; J Health Soc Behav 2020;61:190-207; J Aging Health 2022;34:818-830; Blood Press 2024;33:2405156; Rev Saude Publica 2022;56:64]

“Together, these findings underline the importance of considering disability status as a key determinant of future cardiovascular risk,” they said.

Clinical implications

There are several ways to help improve cardiovascular outcomes in individuals with physical disabilities. The investigators highlighted the provision of targeted interventions (eg, tailored advice on diet, exercise, and BP monitoring), integration of disability-inclusive approaches to cardiovascular risk management into routine primary care, enhancement of access to preventive services, and promotion of inclusive environments.

“Finally, our findings support the need for a broader public health framing of disability, not only as a demographic or social category but also as a clinical indicator of heightened chronic disease risk. Recognizing and acting on this association could yield substantial gains in hypertension prevention and health equity,” they said.

The study included 19,319 participants (57.4 percent female, 84.3 percent White) ages 16 years and older who were hypertension-free at baseline. These participants were followed from 2018–2019 to 2022–2023.

Of the participants, 17.2 percent reported at least one physical disability at baseline. Participants with vs without physical disability were more likely to be older, female, White, and currently smoking. Over the 4-year follow-up, 610 participants (3.2 percent) received a diagnosis of hypertension.

Physical disability was defined as self-reported difficulty, lasting or expected to last at least 12 months, in any of the following functional domains: mobility (moving around at home and walking), lifting/carrying objects, manual dexterity (using hands to carry out everyday tasks), continence (bladder and bowel control), physical coordination, personal care, hearing (apart from using a standard hearing aid), and sight (apart from wearing standard glasses). Incident hypertension was defined as a new self-reported doctor diagnosis of high BP levels during the follow-up.