Epidemiology of Hypertension in Bangladeshi People with Type 2 Diabetes Attending an Urban Healthcare Center: Impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Hypertension Clinical Practice Guidelines

Background The American College of Cardiology (ACC) and the American Heart Association (AHA) lowered the threshold for defining hypertension (HTN) and for control status in 2017. The effect of the new cutoff on the prevalence of HTN and its burden among Bangladeshi people with type 2 diabetes mellitus (T2DM) has not been well studied. This study aimed to assess the prevalence and predictors of HTN, along with the blood pressure (BP) control status among Bangladeshi people with T2DM using the traditional cutoff (HTN: systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg, controlled HTN: <140 and <90 mmHg, respectively) and to see the impact of 2017 ACC/AHA cutoff (HTN: SBP ≥130 mmHg or DBP ≥80 mmHg, controlled HTN: <130 and <80 mmHg, respectively) on the burden of HTN. Methodology This cross-sectional study utilized retrospective data from electronic medical records at a single urban healthcare center from August 2022 to April 2025. Patients with T2DM, aged 18 years or older, were included through a consecutive sampling method. Clinical and demographic information was collected from previous medical records. Patients with gestational diabetes mellitus (DM), T1DM, secondary DM, or T2DM with pregnancy or lactation were excluded. BP was measured using standardized sphygmomanometers under ideal conditions. All abnormal BP readings were cross-checked with repeat measurements at intervals. Data were entered into SPSS (version 25.0; IBM Corp., Armonk, NY) and analyzed. A P-value of <0.05 with a 95% confidence interval (CI) was considered significant. Results Among 1,444 participants (median age: 50 years, interquartile range (IQR) 40-59; body mass index (BMI): 27.2 kg/m2, IQR 24.6-30.2; duration of DM: median 7.0 years, IQR 3.0-13.0; female: 804 (55.7%)), HTN was observed in 929 (64.3%) subjects (previously diagnosed (831, 57.5%), newly diagnosed (98, 6.8%)) using traditional cutoff. Using the 2017 ACC/AHA guideline alarmingly increased the number of newly diagnosed HTN from 98 (6.8%) to 385 (26.7%), raising the total HTN subjects to 1,216 (84.2%). Among previously diagnosed HTN subjects, only 551 (66.3%) were receiving treatment, of whom 286 (51.9%) were maintaining their BP within target ranges, which was reduced to 98 (17.8%) using the 2017 ACC/AHA criteria. Multivariate logistic regression revealed individuals aged 40-59 years had over three times the odds (adjusted odds ratio (AOR): 3.08, 95% CI: 1.87-5.08), and those aged ≥60 had more than six times the odds (AOR: 6.45, 95% CI: 3.04-13.72) of HTN compared to 18-39 years. BMI (23-27.4 kg/m², AOR: 3.64; 95% CI: 1.76-7.50; BMI ≥ 27.5 kg/m², AOR: 3.54; 95% CI: 1.73-7.22 compared to BMI < 23 kg/m²). Poor glycemic control (HbA1c ≥ 7.0%, AOR: 2.01; 95% CI: 1.20-3.35 compared to HbA1c < 7.0%) was independently associated with increased odds of prevalent HTN. However, female sex (P = 0.405) and DM duration ≥10 years (P = 0.523) were not associated with HTN after adjustment. Conclusions Adopting the 2017 ACC/AHA criteria, we observed that roughly four out of five people with T2DM were hypertensive, while only one-fifth had controlled BP.