2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation

Concurrent Type 2 Diabetes, Hypertension More Than Doubles ... - Healio

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on . Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.Com.

Back to Healio

Key takeaways:

Adults with both hypertension and type 2 diabetes had significantly increased risk for all-cause and CV mortality.

Routine BP and glucose screening are needed to help improve diagnoses, researchers concluded.

Adults with both type 2 diabetes and hypertension have more than twice as high of a risk for all-cause mortality and cardiovascular death as those with neither or one of those conditions, according to data published in Diabetes Care.

"We know that hypertension and diabetes are both risk factors for cardiovascular disease and leading causes of mortality in the U.S. And globally," Nour Makarem, PhD, FAHA, assistant professor of epidemiology and co-leader of the chronic disease unit at Columbia University Irving Medical Center's Mailman School of Public Health, told Healio. "However, we uniquely show a strikingly higher mortality risk associated with having these conditions concurrently. Even having coexisting prediabetes and elevated blood pressure was associated with up to 19% higher mortality risk compared with having neither or either of these risk states, suggesting that the increase in mortality risk commences before levels of blood glucose and BP progress to type 2 diabetes and hypertension."

Data were derived from Yuan Y, et al. Diabetes Care. 2025;doi:10.2337/dca24-0118.

Makarem and colleagues obtained National Health and Nutrition Examination Survey data from 1999 to 2018. Adults were considered to have type 2 diabetes if they used insulin or type 2 diabetes medication and had an HbA1c of 6.5% or higher or a fasting glucose of 126 mg/dL or greater. Those with a systolic BP of 130 mm Hg, a diastolic BP of 80 mm Hg or greater, or those who used a BP medication were considered to have hypertension. All-cause and CV mortality were collected from the National Death Index.

There were 48,727 adults included in the study (mean age, 47 years; 52% women; 69% non-Hispanic white). Of the study group, 38.4% had hypertension, 2.4% had type 2 diabetes and 8.7% had both conditions.

Concurrent conditions raise mortality risk

There were 7,734 deaths from any cause and 2,013 CV deaths during median follow-up of 9.2 years. Mortality occurred among 31% of those with type 2 diabetes plus hypertension, 22% with hypertension alone, 20% with type 2 diabetes alone and 6% with neither condition.

Nour Makarem

Adults with hypertension and type 2 diabetes had a higher risk for all-cause mortality (HR = 2.46; 95% CI, 2.45-2.47) and CV mortality (HR = 2.97; 95% CI, 2.94-3) than those with neither condition. Those with coexisting hypertension and type 2 diabetes also had a higher all-cause mortality risk compared with those with hypertension alone (HR = 1.66; 95% CI, 1.65-1.66) and type 2 diabetes alone (HR = 1.35; 95% CI, 1.34-1.36).

Among 21,981 adults without hypertension and type 2 diabetes, researchers assessed mortality risk for adults with either prediabetes as defined by an HbA1c of 5.7% to 6.4% or a fasting glucose of 100 mg/dL to 125 mg/dL, or elevated BP with a systolic BP of 120 mm Hg to 129 mm Hg and a diastolic BP of less than 80 mm Hg. Adults with both prediabetes and elevated BP had a 10% higher all-cause mortality risk and a 19% greater CV mortality risk than adults with neither condition.

In subgroup analysis, the increased risk for all-cause mortality with hypertension plus type 2 diabetes compared with neither condition was stronger among men (HR = 3.2) compared with women (HR = 2.06; P for interaction < .01). All racial/ethnic groups had a similarly higher all-cause mortality risk with type 2 diabetes and hypertension vs. Neither disease.

"These findings underscore the need for routine BP and blood glucose screenings to improve diagnosis rates and more effectively manage both conditions," Makarem said. "Our results highlight the importance of elucidating and implementing therapeutic approaches by health care professionals to better manage these conditions jointly; this includes interventions addressing medication adherence and implementation of evidence-based lifestyle approaches such as 'Food is Medicine' interventions, for example."

Interventions needed

Makarem acknowledged that many people in the U.S. Face barriers toward initiating healthy lifestyle behaviors and said researchers need to develop interventions that could be implemented in a real-world setting.

"In addition, clinical trials that evaluate the impact of multilevel contextual interventions on the prevention and management of multiple cardiometabolic diseases, compression of morbidity and mitigation of disparities are necessary to extend health span in the U.S. Population," Makarem said.

For more information:

Nour Makarem, PhD, FAHA, can be reached at nm2968@cumc.Columbia.Edu.

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on . Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.Com.

Back to Healio

Concurrent Hypertension, Type 2 Diabetes Heightens Mortality Risks

Concurrent hypertension and type 2 diabetes (T2D) is associated with significantly higher all-cause and cardiovascular mortality risks than either condition alone, according to study findings published in Diabetes Care.

Despite the growing pathophysiological associations between multiple cardiometabolic comorbidities and their effects on mortality outcomes, research gaps exist on the association of coexisting T2D and hypertension with all-cause and cardiovascular mortality.

To investigate the relationship between concurrent hypertension and T2D status and all-cause and cardiovascular mortality, researchers conducted a prospective study among US adults. Data were excluded for those under the 20 years of age (n=46,235) and those who had missing BP, hemoglobin A1c (HbA1c), fasting glucose (n=6269), or mortality status (n=85).

"

This study showed that the coexistence of hypertension and T2D is associated with substantially higher all-cause and cardiovascular mortality risk compared with having neither or either of these conditions in US adults and that this higher mortality risk commences with concurrent prediabetes and elevated blood pressure.

The researchers used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between hypertension and T2D status and the risks for all-cause and cardiovascular mortality. Participants were divided into the following mutually exclusive groups:

Individuals with T2D but without hypertension;

Individuals without T2D but with hypertension;

Individuals with both T2D and hypertension; and,

Individuals without T2D and hypertension.

The major outcomes were all-cause and cardiovascular mortalities.

The study included 48,727 participants (mean age, 47 years) from the National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2018. Of these participants, 52% were female, 69% were non-Hispanic White, 14% were Hispanic, and 11% were non-Hispanic Black.

Among all participants, 38.4% had hypertension alone, 2.4% had T2D alone, 8.7% had both T2D and hypertension, and 50.5% did not have T2D or hypertension.

Between 1999 and 2018, the prevalence of concurrent hypertension and T2D in US adults rose from 6% to 12%. This combination was associated with markedly increased risks for all-cause mortality (HR, 2.46; 95% CI, 2.45-2.47) and cardiovascular mortality (HR, 2.97; 95% CI, 2.94-3.00), with stronger associations observed among women (P <.01).

Compared with participants who had either condition alone, those with both conditions had an up to 66% higher all-cause mortality risk and over 54% higher cardiovascular mortality risk, with differences by sex, race, and ethnicity. Concurrent prediabetes and elevated blood pressure also increased mortality risk by up to 19%.

Study limitations include lack of longitudinal data on disease control and medication use, reliance on self-reported measures, potential misclassification of T2D, unmeasured confounding, and limited statistical power for cardiovascular mortality analysis.

The study authors concluded, "This study showed that the coexistence of hypertension and T2D is associated with substantially higher all-cause and cardiovascular mortality risk compared with having neither or either of these conditions in US adults and that this higher mortality risk commences with concurrent prediabetes and elevated blood pressure."

This article originally appeared on Endocrinology Advisor

Concurrent Hypertension + Type 2 Diabetes Predict High Mortality Risk

This website is using a security service to protect itself from online attacks. The action you just performed triggered the security solution. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data.

---