Coexisting Hypertension and Type 2 Diabetes in US Adults Doubled Over 2 Decades: New Study
Adults with both HTN and T2D had more than twice the risk of all-cause mortality and nearly three times the risk of cardiovascular mortality, according to new data.
The prevalence of coexisting hypertension (HTN) and type 2 diabetes (T2D) among US adults nearly doubled between 1999 and 2018, affecting 12% of adults, according to a new study published in Diabetes Care.1
Findings also showed that individuals with both conditions face more than a twofold increased risk of all-cause mortality and nearly a threefold increased risk of cardiovascular death compared to those without these conditions.1
“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,” 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, said in a press release. “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.”2
Makarem and colleagues analyzed data from 48 727 participants from the 1999-2018 National Health and Nutrition Examination Survey (NHANES), representing approximately 200 million US adults. Participants were stratified into 4 groups based on HTN and T2D diagnosis: no HTN or T2D, HTN only, T2D only, and both conditions. All-cause and cardiovascular mortality were assessed using ICD-10 codes, and Kaplan-Meier curves and Cox proportional hazards models were used to evaluate mortality risk associations. Researchers adjusted statistical models for sociodemographic, clinical, and lifestyle factors, according to the study.1
The mean age of participants was 47 years; 52% were women and 69% identified as non-Hispanic White. Overall, 50.5% had neither condition, 38.4% had HTN only, 8.7% had both conditions, and 2.4% had T2D alone.1
Investigators observed that between 1999 and 2018, the prevalence of individuals with both HTN and T2D increased from 6% to 12%. They also noted that coexisting HTN 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.1
"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," Makarem said in a press release.2
In addition, results showed that individuals with both HTN and T2D had significantly higher mortality rates over a median follow-up of 9.2 years. Approximately 33% of individuals with coexisting T2D and HTN died during follow-up, compared with 22% with HTN only, 20% with T2D only, and 6% with neither condition.1
Coexisting T2D and HTN were associated with a twofold increased risk of all-cause mortality (HR 2.46, 95% CI 2.45-2.47) and a threefold increased risk of cardiovascular mortality (HR 2.97, 95% CI 2.94-3.00) compared with those with neither condition, with stronger associations in women compared to men (P <.01).1
“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,” Makarem added in the press release. “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.”2
Makarem and colleagues also found that concurrent HTN and T2D are associated with significantly higher mortality risk compared with having either condition. Specifically, compared to individuals with HTN only, those with coexisting T2D and HTN faced a 66% higher risk of all-cause mortality and a 54% higher risk of cardiovascular mortality. Compared to having T2D alone, having coexisting T2D and HTN was associated with a 25% higher risk of dying from any cause and more than double the risk of cardiovascular mortality.1
The authors emphasized the importance of routine screening for both glucose and blood pressure levels and called for investments in integrated prevention and management strategies targeting multiple cardiometabolic conditions.1
"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," Makarem concluded in the press release.2
References:
1. Yuan Y, Isasi CR, Makarem N, et al. Associations of concurrent hypertension and type 2 diabetes with mortality outcomes: A prospective study of U.S. adults. Diabetes Care. Published online May 21, 2025. doi:10.2337/dca24-0118
2. Burden of Coexisting Hypertension and Type 2 Diabetes in U.S. Adults is Increasing. News release. Columbia University Mailman School of Public Health. May 28, 2025. Accessed May 30, 2025. https://www.publichealth.columbia.edu/news/burden-coexisting-hypertension-type-2-diabetes-u-s-adults-increasing
