Adults in the United States who have both high blood pressure and Type 2 diabetes face a far greater risk of dying—especially from heart-related causes—compared to those who have only one of these conditions or neither, according to a major new study from Columbia University’s Mailman School of Public Health.
The study, published in Diabetes Care, also shows that even people with pre-diabetes and elevated blood pressure—conditions that often come before a full diagnosis—face a higher risk of early death.
High blood pressure (also called hypertension) affects almost half of U.S. adults and is expected to affect 61% of the population by 2050. Type 2 diabetes already impacts about 15% of adults, while over a third have prediabetes.
Without changes in diet or lifestyle, more than half of people with prediabetes will go on to develop full-blown diabetes. And many people end up having both diabetes and high blood pressure at the same time.
“We’re seeing a growing number of people living with both high blood pressure and diabetes,” said Dr. Nour Makarem, the study’s lead author and assistant professor of epidemiology at Columbia. “This combination puts people at a much greater risk for heart disease and death. It’s a clear call for stronger public health efforts to prevent and manage these conditions together.”
The researchers looked at health data from nearly 49,000 adults who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. This data represents the health of about 200 million Americans.
Participants were grouped into four categories: those with neither condition, those with only high blood pressure, those with only diabetes, and those with both.
Over the 20-year period, the number of people with both conditions nearly doubled—from 6% to 12%. People who had both diabetes and hypertension were more likely to be older, have lower income and education levels, and be part of non-Hispanic Black or Hispanic communities.
The health risks were significant. Over an average follow-up period of just over 9 years:
- About 33% of people with both conditions died
- 20% of people with diabetes only died
- 22% of people with hypertension only died
- 6% of people with neither condition died
The study found that people with both conditions had twice the risk of dying from any cause, and three times the risk of dying from heart disease, compared to people with neither condition. These risks were present in all racial and ethnic groups and both sexes, but women seemed to be affected more strongly than men.
Even people with early signs of trouble—those with both prediabetes and slightly high blood pressure—had up to a 19% higher risk of dying compared to people without either condition.
When researchers compared people with one condition to those with both, the increased risk remained high. For example:
- Compared to people with only high blood pressure, those with both conditions had a 66% higher risk of dying from any cause and a 54% higher risk of dying from heart disease.
- Compared to people with only diabetes, those with both had a 25% higher risk of dying from any cause and more than double the risk of dying from heart disease.
These findings underline the importance of regularly checking both blood sugar and blood pressure—especially in communities where heart and metabolic diseases are common. Dr. Makarem and her team stress the need for public health efforts that target multiple chronic conditions at once, not just one at a time.
With the U.S. population getting older and chronic illnesses becoming more common, the study calls for new policies and community programs that help people prevent or manage both diabetes and hypertension. Strategies may include better access to healthcare, support for healthy lifestyle changes, and promoting medication adherence.
“Preventing and controlling these conditions is key to living longer and living healthier,” said Makarem. “We need to extend the number of years people can enjoy good health—not just the number of years they live.”
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The research findings can be found in Diabetes Care.
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