Associations of Concurrent Hypertension and Type 2 Diabetes With Mortality Outcomes: A Prospective Study of U.S. Adults

IF 14.8 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Care Pub Date : 2025-05-21 DOI:10.2337/dca24-0118

Ye Yuan, Carmen R. Isasi, Tala Al-Rousan, Arnab K. Ghosh, Pricila H. Mullachery, Priya Palta, Nour Makarem

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Abstract

OBJECTIVE To investigate associations of concurrent hypertension and type 2 diabetes (T2D) with mortality in U.S. adults and elucidate differences by sex, race, and ethnicity. RESEARCH DESIGN AND METHODS The study population included 48,727 adults from the 1999–2018 National Health and Nutrition Examination Surveys. Participants were categorized into four mutually exclusive categories: 1) no hypertension and no T2D, 2) hypertension only, 3) T2D only, and 4) coexisting hypertension and T2D. Outcomes were all-cause and cardiovascular mortality defined using ICD-10 codes. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to evaluate associations of hypertension and T2D status with mortality risk. RESULTS The burden of concurrent hypertension and T2D doubled between 1999 and 2018 from 6 to 12%. Overall, 50.5% of participants did not have T2D or hypertension, 38.4% had hypertension only, 2.4% had T2D only, and 8.7% had both. During a 9.2-year median follow-up, 7,734 deaths occurred. Concurrent hypertension and T2D versus no hypertension or T2D predicted higher all-cause (hazard ratio 2.46 [95% CI 2.45, 2.47]) and cardiovascular mortality risk (2.97 [2.94, 3.00]), with stronger associations in females versus males (P for interaction < 0.01). Compared with having hypertension or T2D only, concurrent hypertension and T2D predicted up to 66% and more than twofold higher all-cause and cardiovascular mortality risk, respectively, and associations varied by sex and race and ethnicity (P for interaction < 0.01), depending on the reference group (T2D only or hypertension only). Concurrent prediabetes and elevated blood pressure predicted up to 19% higher mortality risk compared with having neither or either condition. CONCLUSIONS 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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并发高血压和2型糖尿病与死亡率结局的关联：一项对美国成年人的前瞻性研究

目的：研究美国成人并发高血压和2型糖尿病（T2D）与死亡率的关系，并阐明性别、种族和民族的差异。研究设计和方法研究人群包括1999-2018年全国健康和营养检查调查的48,727名成年人。参与者被分为四个相互排斥的类别：1)无高血压和无T2D， 2)只有高血压，3)只有T2D， 4)高血压和T2D共存。结果是使用ICD-10代码定义的全因死亡率和心血管死亡率。Kaplan-Meier曲线和多变量Cox比例风险模型用于评估高血压和T2D状态与死亡风险的关系。结果1999年至2018年间，高血压和T2D并发的负担翻了一番，从6%增加到12%。总体而言，50.5%的参与者没有T2D或高血压，38.4%的参与者只有高血压，2.4%的参与者只有T2D， 8.7%的参与者两者都有。在9.2年的中位随访期间，发生了7734例死亡。合并高血压和T2D与不合并高血压或T2D相比预测更高的全因风险（风险比2.46 [95% CI 2.45, 2.47]）和心血管死亡风险（风险比2.97[2.94,3.00]），且女性与男性的相关性更强(P为相互作用&；lt；0.01)。与仅患有高血压或T2D相比，并发高血压和T2D分别预测高达66%和两倍以上的全因和心血管死亡风险，且相关性因性别、种族和民族而异(P为相互作用&；lt；0.01)，取决于参照组（仅T2D或仅高血压）。与没有或没有糖尿病前期和血压升高的人相比，同时患有糖尿病前期和血压升高的人死亡风险高出19%。结论：并发高血压和T2D预测高死亡风险，强调了在美国对延长健康寿命的相关干预措施的迫切需要

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来源期刊

Diabetes Care 医学-内分泌学与代谢

CiteScore

27.80

自引率

4.90%

发文量

449

审稿时长

1 months

期刊介绍： The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.