7 days ago
Concurrent Hypertension and T2D Raises Risk for Mortality
The prevalence of concurrent hypertension and type 2 diabetes (T2D) doubled from approximately 6% to 12% in the United States between 1999 and 2018, with the coexistence of these conditions being associated with a notable increase in the risk for all-cause and cardiovascular mortality.
METHODOLOGY:
Hypertension and T2D are major contributors to morbidity and cardiovascular mortality, both in the United States and globally. Quantifying how each condition, alone or in combination, affects the risk for mortality is essential to guide interventions that reduce chronic disease burden and improve quality of life.
Researchers analyzed data from 48,727 adults (mean age, 47.4 years; 51.8% women) in the 1999-2018 National Health and Nutrition Examination Survey to investigate the associations of concurrent hypertension and T2D with the risk for mortality.
Participants were categorized into four groups: No hypertension and no T2D (50.5%), hypertension only (38.4%), T2D only (2.4%), and coexisting hypertension and T2D (8.7%); sociodemographic and clinical characteristic data were obtained through interview questionnaires.
Participants were followed up for a median duration of 9.2 years, and the outcomes analyzed were all-cause and cardiovascular mortality.
TAKEAWAY:
During the follow-up period, 7734 deaths occurred, including 2013 cardiovascular deaths.
Compared with having neither condition, having concurrent hypertension and T2D predicted a higher risk for both all-cause mortality (hazard ratio [HR], 2.46; 95% CI, 2.45-2.47) and cardiovascular mortality (HR, 2.97; 95% CI, 2.94-3.00), with stronger associations in women than in men ( P for interaction < .01).
for interaction < .01). Compared with having hypertension or T2D only, having concurrent hypertension and T2D predicted an up to 66% higher risk for all-cause mortality and a more than twofold higher risk for cardiovascular mortality.
Having concurrent prediabetes and elevated blood pressure was associated with an up to 19% higher risk for mortality than having neither condition or having just one of the conditions, indicating that the risk for mortality can begin increasing even before developing T2D or hypertension.
IN PRACTICE:
'Given the growing aging population in the US and globally and the associated projected chronic disease burden, our findings underscore the critical need for public health policy and interventions that prevent and address multiple cardiometabolic morbidities to mitigate their downstream impact on further morbidity, extend the lifespan, and preserve quality of life,' the authors wrote.
SOURCE:
This study was led by Ye Yuan, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York City. It was published online on May 21, 2025, in Diabetes Care .
LIMITATIONS:
This study was limited by the lack of longitudinal data on changes in hypertension and T2D status, control, and medication use throughout the follow-up period, hindering the ability to assess how these changes affected the risk for mortality over time. Additionally, the reliance on self-reported data for hypertension and T2D medication use, as well as other covariates such as alcohol use and smoking, may have introduced measurement error.
DISCLOSURES:
Some authors reported receiving grants from the National Heart, Lung, and Blood Institute; American Heart Association; National Institute on Minority Health and Health Disparities; and other sources. The authors reported having no conflicts of interest.
