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

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.