Systematic review and meta analysis of the prevalence of hypertension diabetes and comorbid hypertension diabetes and patterns of healthcare utilization among adults in India

India is witnessing a rapid increase in non-communicable diseases (NCDs), particularly hypertension and diabetes, including the growing challenge of comorbid hypertension-diabetes. These conditions frequently coexist and require sustained, long-term management. The combined burden places significant strain on healthcare systems, particularly in the context of inequities in access, affordability, and continuity of care. This systematic review and meta-analysis aimed to estimate the pooled prevalence of hypertension, diabetes, and comorbid hypertension-diabetes among adults in India and to synthesize evidence on associated health-seeking behaviour and pattern of healthcare utilization. A comprehensive search was conducted across PubMed, Scopus, CINAHL, ProQuest, Web of Science, and J-Gate for studies published between January 2013 and August 2025. The review followed PRISMA guidelines, and methodological quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analysis was used to estimate pooled prevalence with 95% confidence intervals. Gender-based subgroup analyses and sensitivity analyses were performed. Publication bias was assessed using funnel plot inspection and Egger’s regression test for asymmetry. Health-seeking behaviour and pattern of Healthcare utilization findings were synthesized narratively. Fifty studies (43 cross-sectional surveys and 7 national datasets), including over 6.4 million adults, met the inclusion criteria. The pooled prevalence of hypertension was 34.84% (95% CI 31.33%-38.35%), diabetes was 15.37% (95% CI 14.03%-16.71%), and comorbid hypertension-diabetes was 46.13% (95% CI 40.55%-51.77%). Gender-specific analyses showed comparable burdens across men and women. Health-seeking behaviour and Pattern of healthcare utilization revealed a strong preference for private healthcare facilities despite high out-of-pocket expenditures, while public services were often underutilized due to perceived quality gaps, distance, medication shortages, and long waiting times. Financial constraints, limited health literacy, and gender-related barriers contributed to delayed diagnosis, fragmented care, and suboptimal treatment adherence. The substantial and overlapping burden of hypertension and diabetes in India, combined with inequitable and fragmented healthcare utilization, highlights the need for integrated screening and management strategies. Strengthening primary healthcare through Health and Wellness Centres, expanding community-based adherence support, improving financial protection, and addressing gender and awareness gaps are essential to improving chronic disease outcomes. Protocol Registration The review protocol was prospectively registered with the PROSPERO database (CRD420251023095).