High blood pressure, also known as hypertension, is a common disorder affecting roughly ⅓ of UK adults and an estimated 1.28 billion adults worldwide. On its own, it has barely noticeable symptoms; however, it increases the risk of other cardiovascular disorders such as angina or a heart attack and is linked to poorer outcomes in COVID-19 infections.1,2 This article will explore blood pressure and whether high blood pressure can cause pain in the chest.
What is Blood Pressure?
We can think of our bodies in the same way as a water pipe system in a house. In our body (the house), there are various veins and arteries (the water pipes) supplying our muscles, organs and the brain (the appliances in our home), which are connected to the heart (the boiler). In a house, various water pipes supply radiators, taps, or showers connected to a boiler. The heart creates pressure in the system when it pumps to generate blood flow. Pressure is the force that blood exerts on the walls of blood vessels. However, the heart does not create constant pressure. When the heart contracts, it increases blood pressure to its maximum, known as systolic pressure. After the heart contracts, it relaxes to allow blood to fill the heart's chambers. During this process, blood pressure drops to its lowest point, known as diastolic pressure.
How is Blood Pressure Measured?
Blood pressure is measured with a device called a cuff monitor. This standard piece of equipment in a doctor’s arsenal is freely available to purchase. They can come as a simple cuff and stethoscope or an electronic version without a stethoscope. However, both operate on the same principle.
It consists of an arm cuff placed around the upper arm, inflated to cut circulation in the brachial artery. The cuff is then slowly deflated to allow circulation to return. The point where the heart can overcome the resistance of the cuff and return circulation is the systolic pressure. However, the blood flow is not smooth at this point and creates a phenomenon known as Korotkoff sounds. Once these sounds disappear, the blood is once again flowing soft, and this point is where diastolic pressure can be found. But what are the numbers of these pressures?
A monitor will express readings in pairs to represent systolic and diastolic pressure.3 The units used for the readings are millimetres of mercury (mmHg), a standard measure of pressure. You may have heard the phrase “120 over 80” before on TV, and this is roughly what is a healthy reading of blood pressure. However, healthy blood pressure ranges from 90/60 to 120/80. 120/80 means that systolic pressure gives a reading of 120 mmHg and diastolic pressure gives a reading of 80 mmHg.
How High is “High” Blood Pressure?
High blood pressure is diagnosed when pressure is high on two different days. High blood pressure is diagnosed at ≥140/≥90.4. These measurements are only 20 mmHg and 10 mmHg from what can be considered healthy blood pressure. Therefore, it is vital for individuals to continually check their blood pressure if they are at risk of high blood pressure.
Can High Blood Pressure Cause Chest Pain?
High blood pressure is known as a silent killer and often doesn’t have any symptoms. This again shows why it is vital to measure blood pressure at the GP or by yourself continuously. However, severe blood pressure can cause chest pains.5 The sensation of chest pains can manifest in various ways. Commonly, it can feel like a tightness or heaviness in the chest. However, it can also feel like a sharp stabbing or dull ache of chest discomfort. In addition, the pain can be limited to one side or specific area of the chest and spread to the arms or neck/jaw.
What is Pulmonary Hypertension?
Pulmonary hypertension is a specific kind of high blood pressure that affects the lungs. It occurs in the blood vessels that supply blood from the heart to the lungs, known as pulmonary arteries. These arteries originate from the right side of the heart. The consequence is that the right side of the heart has to work harder to pump blood to the lungs. Over time, this weakens the heart leading to heart failure.
This high blood pressure cannot be measured using the cuff technique as the blood vessels are not in the same system. To measure pulmonary blood pressure, a doctor can administer a non-invasive test called an echocardiogram which uses sound waves to assess both sides of the heart and estimate blood pressure. Alternatively, an invasive technique that uses a catheter passed from the neck to the pulmonary arteries can accurately measure blood pressure.6
The symptoms of pulmonary hypertension largely overlap with normal high blood pressure, having all the symptoms listed above. Importantly, pulmonary hypertension can cause chest pains.7 Chest pain is mainly caused after exercise. If you have normal blood pressure and no other apparent signs of causing chest pains, your doctor may administer the tests outlined above.
Other Possible Causes of Chest Pain
While high blood pressure is a cause of chest pain, other reasons might be more likely as symptoms often do not occur in high blood pressure. Other potential causes of chest pain include:7
- Heart Attack:
- It occurs when blood supply is suddenly blocked to the heart muscles. This can happen due to a blood clot or coronary artery disease.
- Chest pain lasts more than 15 minutes and often spreads to the left arm.
- It occurs when blood supply to the heart is restricted.
- There are two forms:
- Stable angina - Chest pains are predictable with triggers such as exercise and will relive after a few minutes.
- Unstable angina - Chest pains are unpredictable with no trigger and often do not get better with rest.
- Pulmonary Embolism:
- It occurs when blood supply is suddenly blocked to the lungs. Again it can be caused by a blood clot.
- Chest pains are characterised by sharp stabbing that gets worse when breathing in.
- It occurs when there is inflammation of the sac surrounding the heart.
- Chest pain is a sharp stabbing pain that can worsen when lying down.
- Lung Conditions:
Other causes of chest pain not related to the heart and lungs:
- Strained muscle - The pectoral muscles can be sprained, causing them to be painful and tender to touch.
- Panic attack or anxiety/stress.
Other Signs and Symptoms of High Blood Pressure
Some symptoms develop moderate high blood pressure levels, such as buzzing in the ears. In comparison, severe blood pressure can create more apparent symptoms such as vomiting. There are a lot of other signs to look out for with high blood pressure as listed below:
- Blurred vision
- Nose bleeds
- Shortness of breath/fatigue
- Headaches/buzzing in ears
- Muscle tremors
Risk Factors for High Blood Pressure
Various risks can contribute to high blood pressure. These can be linked to our lifestyle choices such as too much alcohol, poor diet, physical inactivity and tobacco use. These choices often lead to obesity and high cholesterol levels. However, risk factors can be out of our control and be related to genetics. When diagnosing high blood pressure, a doctor may look at your family medical history to see whether factors are out of your control, including age, sex, race/ethnicity, and prevalence in your family tree.
Treatment, Management and Prevention of High Blood Pressure
Treatment can involve high blood pressure medicines such as ACE inhibitors or calcium channel blockers. These are prescribed based on the age and ethnicity of an individual. For more information on medications, please see here and UK government advice. However, lifestyles such as changes to your diet to manage cholesterol or increased exercise will also manage high blood pressure. The prevention of high blood pressure also relates to lifestyle changes such as a healthy diet, increased activity, decreased alcohol intake or limited caffeine.
When to Call a Doctor or Dial 999
Please call a doctor or dial 999 when you are experiencing:
- Chest pain that does not go away or radiates to other parts of the body
- Irregular heartbeat
- Difficulty breathing
High blood pressure occurs for various reasons and is diagnosed at a blood pressure of ≥140/≥90 mmHg. High blood pressure can cause chest pains but often does not cause noticeable symptoms. You should regularly check your blood pressure at the GP for high blood pressure.
- Basu A, Agwu JC, Barlow N, Lee B. Hypertension is the major predictor of poor outcomes among inpatients with COVID-19 infection in the UK: a retrospective cohort study. Bmj Open. 2021;11(6).
- Omstedt A, Hoijer J, Djarv T, Svensson P. Hypertension predicts major adverse cardiac events after discharge from the emergency department with unspecified chest pain. European Heart Journal-Acute Cardiovascular Care. 2016;5(5):441-8.
- Berge HM, Isern CB, Berge E. Blood pressure and hypertension in athletes: a systematic review. British Journal of Sports Medicine. 2015;49(11):716-23.
- Alismail AI, Alosaimi WA, Faqihi AY, Al-Sahagi RJN, Alfraiji AF, Aloofy OA, et al. Hypertension Diagnosis and Management Approach. International Journal of Pharmaceutical Research and Allied Sciences. 2020;9(1):84-8.
- Stakos DA, Tziakas DN, Chalikias G, Mitrousi K, Tsigalou C, Boudoulas H. Chest Pain in Patients with Arterial Hypertension, Angiographically Normal Coronary Arteries and Stiff Aorta: The Aortic Pain Syndrome. Hellenic Journal of Cardiology. 2013;54(1):25-31.
- Noordegraaf AV, Bogaard HJ, Groeneveldt JA, Nossent EJ, Boonstra A, Torbicki A. Pulmonary hypertension: diagnosis, differential diagnosis and pitfalls. Pulmonary Hypertension. 2012(57):17-25.
- Rajmohan D, Sung YK, Kudelko K, Perez VD, Haddad F, Tremmel JA, et al. Myocardial bridge: an unrecognized cause of chest pain in pulmonary arterial hypertension. Pulmonary Circulation. 2020;10(1).