Key result
Over 20% of hypertensive adults have concurrent diabetes and hyperlipidemia, with only one-quarter controlled.
Why the study?
Hypertension-related deaths in the United States have sharply increased over the past decade, necessitating understanding of trends in cardiometabolic risk factors among adults with hypertension.
Cross-Sectional (n=21,822)
Yes
The burden of cardiometabolic risk factors among U.S. adults with hypertension has significantly increased over the past two decades, while treatment and control rates have plateaued at suboptimal levels since the late 2000s.
BACKGROUND: Hypertension-related deaths in the United States have sharply increased over the past decade. Understanding factors behind this concerning trend is crucial to guide public health strategies. OBJECTIVES: This study sought to examine changes in prevalence, treatment, and control of cardiometabolic risk factors among U.S. adults with hypertension. METHODS: Using National Health and Nutrition Examination Survey, we identified 21,822 adults with hypertension from 1999 to 2023. Trends in age-adjusted prevalence of diabetes, hyperlipidemia, obesity, smoking, and high-risk drinking, as well as in age-adjusted treatment and control rates for hypertension, diabetes, and hyperlipidemia, were assessed. RESULTS: In adults with hypertension, prevalence of diabetes increased from 17.2% (95% CI: 14.6%-20.2%) in 1999-2000 to 27.8% (95% CI: 25.2%-30.7%) in 2021-2023. Among patients with hypertension and diabetes, the proportion receiving treatment for both conditions rose until 2009-2010 but subsequently plateaued (71.6% in 2021-2023; 95% CI: 67.5%-75.4%). A similar trend was observed for the proportion achieving control of both conditions, which remained at 31.2% in 2021-2023 (95% CI: 26.5%-36.3%). Prevalence of hyperlipidemia decreased in adults with hypertension but was still high at 73.1% (95% CI: 70.6%-75.4%) in 2021-2023. Among patients with hypertension and hyperlipidemia, treatment and control rates for both conditions increased only until around 2007; the respective rates were 50.4% (95% CI: 47.2%-53.6%) and 32.3% (95% CI: 29.5%-35.2%) in 2021-2023. Prevalence of concurrent diabetes and hyperlipidemia in adults with hypertension nearly doubled from 12.5% (95% CI: 10.6%-14.7%) in 1999-2000 to 21.3% (95% CI: 19.0%-23.8%) in 2021-2023. Among patients with hypertension, diabetes, and hyperlipidemia, the treatment rate for all 3 conditions increased until 2007-2008 and plateaued afterward (62.1% in 2021-2023; 95% CI: 56.6%-67.2%). The control rate for all 3 conditions followed a similar trend but remained low at 26.3% (95% CI: 20.8%-32.6%) in 2021-2023. Prevalence of obesity and high-risk drinking increased over time, whereas prevalence of smoking held steady. CONCLUSIONS: The burden of cardiometabolic risk factors among U.S. adults with hypertension has increased overall, with concurrent diabetes and hyperlipidemia now affecting more than 1 in 5. Only one-quarter of adults with hypertension, diabetes, and hyperlipidemia have all 3 conditions controlled-a proportion that has not improved in more than a decade.
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Lee et al. (2025) conducted a cross-sectional in Hypertension (n=21,822). Calendar year (1999-2023) vs. Earlier time periods was evaluated on Trends in age-adjusted prevalence, treatment, and control rates of diabetes, hyperlipidemia, obesity, smoking, and high-risk drinking. Between 1999 and 2023, the prevalence of concurrent diabetes and hyperlipidemia in U.S. adults with hypertension rose from 12.5% to 21.3%, while control of all three conditions remained low at 26.3%.
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