U.S. adults with both hypertension and Type 2 diabetes (T2D) face a significantly higher risk of all-cause and cardiovascular mortality compared to those with only one of these conditions-or neither, reports a new study from Columbia University Mailman School of Public Health. The results also reveal that even the combination of prediabetes and elevated blood pressure, representing risk states that precede progression to T2D and hypertension, respectively, is linked to higher mortality risk. The findings are published in the journal Diabetes Care, the Journal of the American Diabetes Association.
"Hypertension affects nearly half of U.S. adults, and prevalence is projected to increase to 61 percent by 2050. Type 2 diabetes currently affects about 15 percent of U.S. adults, and over one-third have prediabetes. Without intervention, more than half of those with prediabetes will develop diabetes," said Nour Makarem, PhD, assistant professor of Epidemiology and co-leader of the Chronic Disease Unit at Columbia University's Mailman School of Public Health and the study's senior author. "Importantly, there is a growing population of U.S. adults living with co-existing T2D and hypertension, putting them at increased risk for cardiovascular disease and mortality. This underscores the urgent need for public health strategies to effectively prevent and manage these conditions and reverse these adverse trends."
Researchers analyzed data from 48,727 adults participating in the National Health and Nutrition Examination Survey (1999-2018), representing approximately 200 million U.S. adults. Participants were categorized into four groups: no hypertension or T2D; hypertension only; T2D only; and both conditions.
Between 1999 and 2018, the prevalence of coexisting hypertension and T2D increased from 6 percent to 12 percent in the U.S. population. The study found that coexisting hypertension and T2D were more common among older adults, those with lower income and education levels, and were disproportionately prevalent among non-Hispanic Black and Hispanic adults compared with non-Hispanic White adults.
"One of the strengths of our study is the use of nationally representative data spanning two decades. A striking finding is that the burden of co-existing hypertension and type 2 diabetes nearly doubled over the study period. Overall, about two thirds of participants with diabetes also had hypertension, and about a quarter of adults with hypertension had concurrent diabetes," said Makarem.
Mortality rates were highest among those with both conditions. Over a median follow-up period of 9.2 years, about a third of participants with co-existing hypertension and T2D died, compared with 20 percent of those with T2D only, 22 percent of those with hypertension only, and just 6 percent of those with neither condition.
The study found that having co-existing hypertension and T2D doubles the risk of dying from any cause and triples the risk of dying from cardiovascular disease, compared to having neither of these conditions. These associations were observed across all racial and ethnic groups and in both sexes, but were generally stronger in females compared with males.
"Even having co-existing prediabetes and elevated blood pressure was associated with up to 19 percent higher mortality risk, compared to having neither or either of these risk states," said Makarem. "This suggests that the increase in risk of dying commences before levels of blood glucose and blood pressure progress to Type 2 diabetes and hypertension."
Study findings also showed that co-existing T2D and hypertension are associated with substantially higher mortality risk compared with having either condition (T2D only or hypertension only). Specifically, compared to having hypertension only, having co-existing T2D and hypertension was linked to 66 percent and 54 percent higher risk of dying from any cause and from cardiovascular disease, respectively. On the other hand, compared to having diabetes only, having co-existing T2D and hypertension was related to 25 percent higher risk of dying from any cause and more than double the risk of dying from heart disease.
These results highlight the importance of routine screening for both blood pressure and glucose-particularly in communities with high rates of cardiometabolic disease. Makarem and co-authors advocate for investing in prevention efforts as well as integrated management strategies, including improved medication adherence and adoption of evidence-based lifestyle interventions.
"Given the aging U.S. population and the projected rise in chronic disease, our findings underscore the urgent need for innovative public health interventions and policies that address multiple cardiometabolic conditions simultaneously and prioritize chronic disease prevention and the extension of health span meaning the number of years of life lived healthy," said Makarem.
Co-authors are Ye Yuan, Columbia Mailman School; Carmen Isasi, Albert Einstein College of Medicine; Tala Al-Rousan, University of California, San Diego; Arnab Ghosh, Weill Cornell College of Medicine; Pricila Mullachery, College of Public Health, Temple University; and Priya Palta, University of North Carolina at Chapel Hill School of Medicine.
The study was supported by National Heart, Lung, and Blood Institute (NHLBI) grants R00-HL148511, K23-HL148530, and K08HL163329; American Heart Association grants 855050 and 24FIM1267661; National Institute of Minority Health and Health Disparities grants P50MD017341 and P50MD017341-03S2; National Institute on Aging grant 2P30AG059299; National Institute of Diabetes and Digestive and Kidney Diseases grant P30DK111022.
