A RECENT large-scale study of nearly 50,000 adults in the United States has revealed a strikingly high risk of death associated with the coexistence of Type 2 diabetes (T2D) and hypertension. Using two decades of national survey data, researchers examined how these common chronic conditions interact to influence mortality, with significant implications for clinicians managing cardiometabolic health. A key finding was that individuals with both T2D and hypertension faced more than double the risk of cardiovascular mortality compared with those without either condition.
This analysis utilised data from the National Health and Nutrition Examination Surveys (1999–2018), encompassing 48,727 adults who were categorised into four distinct groups: those with neither T2D nor hypertension, those with either T2D alone, those with hypertension alone, and those with both. The study linked participants to death records using ICD-10 codes, enabling robust analysis of both all-cause and cardiovascular mortality through Kaplan-Meier survival estimates and Cox proportional hazards models. Results were stratified by sex, race, and ethnicity to assess subgroup variation.
Over a median follow-up of 9.2 years, 7,734 deaths were recorded. Participants with both hypertension and T2D had markedly elevated risks of all-cause (hazard ratio [HR]: 2.46; 95% CI: 2.45–2.47) and cardiovascular mortality (HR: 2.97; 95% CI: 2.94–3.00) compared to those without either condition. Notably, these risks were significantly higher in females than in males (p value for interaction < 0.01). Compared to individuals with only hypertension or T2D, those with both faced up to 66% higher all-cause mortality and more than double the cardiovascular mortality risk. Increases in mortality risk were also seen in those with prediabetes and elevated blood pressure, though to a lesser extent.
The study highlights a pressing need for integrated approaches to managing cardiometabolic risk, particularly in patients presenting with both T2D and hypertension. Differences in mortality risk by sex and ethnicity suggest that tailored interventions could enhance outcomes. However, the observational design limits causal inference, and reliance on baseline data may underestimate evolving risk profiles. Nonetheless, these findings provide compelling evidence to support more aggressive clinical strategies in this high-risk population.
Reference
Yuan Y et al. Associations of Concurrent Hypertension and Type 2 Diabetes With Mortality Outcomes: A Prospective Study of U.S. Adults. Diabetes Care. 2025;DOI: 10.2337/dca24-0118.
