Iron Deficiency Does Not Cause Hypertension
Low iron does not cause high blood pressure in the general population. The available evidence does not establish a causal relationship between iron deficiency and systemic arterial hypertension. In fact, the provided guidelines and research focus on iron deficiency in the context of heart failure, gastrointestinal conditions, and pulmonary hypertension—not systemic hypertension.
Key Evidence Analysis
No Direct Link to Systemic Hypertension
The ESC Heart Failure Guidelines discuss iron deficiency as contributing to muscle dysfunction and anemia in heart failure patients, but make no mention of iron deficiency causing elevated systemic blood pressure 1.
The AGA guidelines on iron deficiency anemia extensively cover gastrointestinal causes and management but do not identify hypertension as a consequence of iron deficiency 1.
CDC-based guidelines detail neuropsychiatric effects, developmental delays, and cognitive impairment from iron deficiency, but hypertension is notably absent from the list of complications 2, 3, 4.
Pulmonary Hypertension: A Different Entity
Iron deficiency is associated with pulmonary arterial hypertension (PAH), which affects the pulmonary circulation, not systemic blood pressure 5, 6, 7, 8.
In PAH patients, iron deficiency is present in 33-46% of cases and correlates with reduced exercise capacity and worse outcomes, but this represents elevated pressure in lung vessels, not the systemic arterial system 5, 7.
Randomized trials of iron supplementation in PAH patients showed no improvement in exercise capacity or hemodynamics, further suggesting the relationship is associative rather than directly causal 6.
Rare Exception: Benign Intracranial Hypertension
One case report documented benign intracranial hypertension (increased pressure around the brain) associated with severe iron deficiency anemia, which resolved with iron treatment 9.
This represents elevated cerebrospinal fluid pressure, not systemic arterial hypertension, and is an extremely rare complication 9.
Clinical Implications
When evaluating a patient with both iron deficiency and hypertension:
Treat these as separate, coexisting conditions rather than causally related 1, 4.
Address hypertension according to standard guidelines (ACE inhibitors, beta-blockers, diuretics, etc.) 1.
Manage iron deficiency based on underlying cause (blood loss, malabsorption, increased demands) with oral or intravenous iron as appropriate 1, 4.
Screen for common causes of iron deficiency: gastrointestinal bleeding in men and postmenopausal women (62% have GI lesions), menstrual blood loss in premenopausal women, and dietary insufficiency 2.
Common Pitfall to Avoid
Do not delay standard hypertension treatment while investigating or treating iron deficiency, as there is no evidence that correcting iron stores will lower systemic blood pressure 1, 4.