Coexisting HTN, T2D in US Adults Doubled Over 2 Decades: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On May 30, 2025, we reported on a study published in Diabetes Care that was designed to examine associations of concurrent hypertension (HTN) and type 2 diabetes (T2D) with mortality in US adults.

The study

Investigators 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. 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.

The findings

Between 1999 and 2018, the prevalence of individuals with both HTN and T2D increased from 6% to 12%, according to the results. Investigators also observed 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.

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. 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).

Authors' comments

"Concurrent hypertension and T2D predict high mortality risk, underscoring the critical need for contextual interventions that extend healthspan in the U.S."

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