A comprehensive analysis of nearly 49,000 US adults reveals that the prevalence of concurrent hypertension and type 2 diabetes has doubled over two decades, creating a mounting public health crisis with significantly elevated mortality risks. The study, published in Diabetes Care, found that 12% of the US population had both conditions in 2018, up from 6% in 1999.
Dramatic Increase in Mortality Risk
Researchers from Columbia University's Mailman School of Public Health analyzed data from the National Health and Nutrition Examination Survey spanning 1999 to 2018. Their findings demonstrate that individuals with both hypertension and type 2 diabetes face more than twice the risk of all-cause mortality (HR, 2.46; 95% CI, 2.45-2.47) and nearly three times the risk of cardiovascular mortality (HR, 2.97; 95% CI, 2.94-3.00) compared to those with neither condition.
"A striking finding is that the burden of co-existing hypertension and type 2 diabetes nearly doubled over the study period," said senior researcher Nour Makarem, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health. "Overall, about two-thirds of participants with diabetes also had hypertension, and about a quarter of adults with hypertension had concurrent diabetes."
Mortality Patterns Across Different Groups
Over a median follow-up period of 9.2 years, the study documented 7,734 deaths, including 2,013 cardiovascular-related deaths. The mortality rates varied dramatically by condition status:
- 31% of participants with concurrent type 2 diabetes and hypertension died during follow-up
- 22% of those with hypertension only
- 20% of those with type 2 diabetes only
- 6% of those with neither condition
The study population consisted of 48,727 individuals with a mean age of 47 years, 52% female, and 69% non-Hispanic White. Among participants, 50.5% had neither condition, 38.4% had hypertension alone, 8.7% had both conditions, and 2.4% had type 2 diabetes alone.
Comparative Risk Analysis
When examining specific comparisons, the research revealed significant differences in mortality risk:
- Compared to having high blood pressure only, having both conditions increased risk of premature death from any cause by 66% and heart-related death by 54%
- Compared to having type 2 diabetes only, having both increased risk of premature death by 25% and more than doubled the risk of heart-related death
Having only hypertension was associated with a 48% increased risk of all-cause mortality and a 93% increased risk of cardiovascular mortality, while participants with type 2 diabetes alone had an 82% higher risk of all-cause mortality and a 25% higher risk of cardiovascular mortality.
Early Warning Signs
The study also examined the impact of pre-clinical conditions, revealing concerning trends even before full disease development. "Even having co-existing prediabetes and elevated blood pressure was associated with up to 19% higher mortality risk, compared to having neither or either of these risk states," Makarem explained.
Participants with both elevated blood pressure and prediabetes had a 19% higher risk of all-cause mortality compared with those with elevated blood pressure alone, and a 13% higher risk of cardiovascular mortality than those with prediabetes alone.
"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," Makarem noted.
Public Health Implications
The researchers emphasized the urgent need for comprehensive intervention strategies. "Understanding the contribution of having multiple cardiometabolic morbidities to mortality risk in the US population is key for informing individual and population-level interventions aimed at addressing the chronic disease burden, compressing morbidity, and extending the lifespan while preserving quality of life," the authors wrote.
"This underscores the urgent need for public health strategies to effectively prevent and manage these conditions and reverse these adverse trends," Makarem concluded.
The study acknowledged limitations including the lack of longitudinal data on changes in hypertension and type 2 diabetes status, control, and medication use during follow-up, which prevented assessment of how changes in glycemic and blood pressure control might influence mortality risk over time.
