Hypertension in People with Multiple Sclerosis: Epidemiology, Mechanisms, Hypertensive Disorders of Pregnancy, and Clinical Implications

Hypertension is a major cardiovascular risk factor, but its epidemiology in people with multiple sclerosis (PwMS) remains unclear. Whether PwMS have a higher prevalence of hypertension than the general population, the potential pathways linking the two conditions, and the association between hypertension and MS-related outcomes remain incompletely understood. This narrative review summarizes current evidence on the prevalence of hypertension in PwMS, examines potential immunological, autonomic, vascular, behavioral, and treatment-related pathways that may link MS and hypertension, and explores how MS disease-modifying therapies may influence blood pressure regulation. It also reviews evidence on the association between hypertension and neurological disability, mobility, cognitive function, visual outcomes, and markers of neurodegeneration in PwMS, as well as hypertensive disorders of pregnancy in women with MS. Finally, it discusses the clinical implications of these findings and identifies priorities for future research.