A new study from Columbia University Mailman School of Public Health has found that U.S. adults with both hypertension and Type 2 diabetes (T2D) face a significantly higher risk of death from all causes and cardiovascular disease compared to those with only one of these conditions, or neither. The study, published in Diabetes Care, also highlighted that even those with prediabetes and elevated blood pressure—early risk factors for developing T2D and hypertension—face an increased mortality risk.
Hypertension now affects nearly half of U.S. adults, a figure expected to rise to 61 percent by 2050. T2D affects about 15 percent of the population, with more than one-third having prediabetes. Left unaddressed, over 50 percent of individuals with prediabetes will develop diabetes. “The growing number of U.S. adults with both T2D and hypertension is alarming, as they are at heightened risk for cardiovascular disease and early death,” said Nour Makarem, PhD, lead author and assistant professor of Epidemiology at Columbia University. “This underscores the need for stronger public health strategies to prevent and manage these conditions.”
The researchers analyzed data from 48,727 adults in the National Health and Nutrition Examination Survey (1999–2018), representing approximately 200 million U.S. adults. Participants were grouped into four categories: no hypertension or T2D, hypertension only, T2D only, and both conditions.
Over the study period, the prevalence of adults with both hypertension and T2D nearly doubled, from 6 percent to 12 percent. The conditions were more common among older adults, those with lower income and education levels, and disproportionately among non-Hispanic Black and Hispanic adults. “About two-thirds of adults with T2D also had hypertension, and one-quarter of adults with hypertension had T2D,” said Makarem.
Higher Mortality Risk with Combined Conditions
The study showed the highest mortality rates among those with both hypertension and T2D. Over a median follow-up of 9.2 years, about one-third of participants with both conditions died, compared to 20 percent of those with only T2D, 22 percent with only hypertension, and just 6 percent with neither condition.
Having both hypertension and T2D was found to double the risk of death from any cause and triple the risk of cardiovascular disease compared to those with neither condition. This risk was consistent across all racial and ethnic groups, though it was stronger in females than males.
“Even those with prediabetes and elevated blood pressure had up to a 19 percent higher risk of mortality,” said Makarem. “This suggests that the risk begins before blood pressure or blood glucose levels reach the thresholds for full-blown T2D and hypertension.”
Calls for Improved Screening and Prevention
The study also highlighted that those with both conditions face significantly higher mortality risks compared to individuals with either condition alone. Specifically, those with both T2D and hypertension had a 66 percent higher risk of death from any cause and a 54 percent higher risk of cardiovascular disease than those with hypertension alone. When compared to those with T2D alone, the risk of dying from any cause was 25 percent higher, while the risk of heart disease more than doubled.
These findings emphasize the importance of routine screening for blood pressure and glucose levels, especially in communities with high rates of cardiometabolic diseases. Makarem and her co-authors advocate for integrated management approaches, improved medication adherence, and lifestyle interventions to help reduce these risks.
“As the U.S. population ages and chronic diseases rise, we urgently need public health policies that address multiple conditions at once, with a focus on prevention and extending the number of years people live in good health,” said Makarem.
The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) and several other health organizations.
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