Association between hypertension and impaired lung function among adults: A systematic review and meta-analysis

Abstract Background Impaired lung function and hypertension are both significant global public health concerns, and their potential association has recently drawn considerable interest. This systematic review and meta-analysis aim to investigate the association between impaired lung function and hypertension, and vice versa. Methods We searched CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus and Web of Science up to 22 144 July 2025 for observational studies involving adults (≥ 18 years) reporting hypertension and impaired lung function. Grey literature was also searched, and data extraction was verified independently. The review was registered with PROSPERO (CRD42023427631). Random effects models estimated pooled ORs with 95% CIs. Subgroup analysis and meta-regression were performed to identify potential sources of heterogeneity. Quality assessment was conducted using Newcastle-Ottawa Scale and JBI checklist and publication bias were appraised. Results This systematic review included 28 articles, of which 26 articles were selected for the meta-analysis. Of these, 17 studies (n=134823) examined impaired lung function as the exposure, while 9 studies (n=12522) investigated hypertension as the exposure. Our findings revealed that the pooled unadjusted effect of lung function impairment on hypertension was 1.70 (95% CI: [1.53–1.88]), while the pooled adjusted effect was lower at 1.40 (95% CI: [1.31–1.49]). In contrast, the pooled unadjusted effect of hypertension on lung impairment was 3.00 (95% CI: [1.86 – 4.82]), but the pooled adjusted effect decreased to 1.94 (95% CI: [1.51 – 2.50]). The findings indicate obstructive, restrictive and mixed lung function impairments are significantly associated with hypertension. Restrictive lung impairment consistently shows a stronger association with hypertension compared to obstructive impairment when impaired lung function is the exposure. Conclusion This study concludes that there is a significant positive relationship between impaired lung function and hypertension, with temporal evidence supporting a causal pathway from impaired lung function to hypertension, though the reverse causal direction lacks such evidence.