European Journal of Cardiovascular Medicine

Hypertension and diabetes mellitus are among the most prevalent non-communicable diseases globally, contributing significantly to morbidity and mortality [1]. The World Health Organization (WHO) estimates that over 1.28 billion adults aged 30–79 years live with hypertension, and nearly 537 million adults have diabetes [2,3]. The coexistence of both conditions, often termed comorbid hypertension and diabetes, poses a critical public health challenge, especially in low- and middle-income countries, where healthcare resources are limited [4].

The pathophysiological link between hypertension and diabetes is multifactorial, involving insulin resistance, endothelial dysfunction, and chronic low-grade inflammation [5]. This comorbidity accelerates target organ damage, including nephropathy, retinopathy, and cardiovascular complications, leading to premature morbidity and mortality [6,7]. In South Asia, particularly Bangladesh, urbanization, sedentary lifestyles, and dietary transitions have amplified the burden of these chronic conditions [8].

Bangladesh is currently facing a dual epidemic of hypertension and diabetes. The Bangladesh Demographic and Health Survey (BDHS 2017–18) reported hypertension prevalence of approximately 25%, while diabetes affects around 10% of adults [9]. However, hospital-based studies indicate substantially higher rates, particularly among elderly and urban populations [10]. The co-occurrence of these conditions increases healthcare utilization and costs, placing substantial strain on the public health system [11]. Despite their growing burden, limited research has explored the detailed comorbidity profile and clinical characteristics of patients with both hypertension and diabetes in Bangladeshi clinical settings.

Several recent studies have addressed aspects of comorbidity. Approximately 4.5% of adults in Bangladesh had both conditions at the community level [10]. Similar trends have been observed in India and Sri Lanka, suggesting a regional epidemiological pattern [12,13]. Moreover, obesity, older age, and urban residency have been consistently associated with dual comorbidity. These findings underscore the importance of hospital-based research to delineate the local disease patterns, treatment practices, and associated complications.

Given the substantial clinical and economic implications, understanding the comorbidity profile of hypertension and diabetes among middle-aged and elderly patients is vital for developing evidence-based interventions. Therefore, this study aimed to assess the comorbidity patterns, associated clinical parameters, and complication burden of hypertension and diabetes among patients attending Mymensingh Medical College Hospital.

This cross-sectional analytical study was conducted at the Department of Cardiology, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh, between June 2023 and July 2024. The study aimed to assess the comorbidity profile of HTN and DM among middle-aged and elderly patients attending outpatient medical services. A total of 250 participants aged 45 years and above were included.

Sample Selection

Inclusion Criteria

• Adults aged ≥45 years.
• Diagnosed cases of hypertension, diabetes, or both based on physician confirmation or medical records.
• Patients attending the outpatient department during the study period.
• Those who provided informed written consent to participate.

Exclusion Criteria

• Individuals below 45 years of age.
• Patients with severe cognitive impairment or terminal illness.
• Pregnant or postpartum women.
• Patients are unwilling to provide consent or with incomplete medical data.

Data Collection and Study Procedure

Data were collected using a structured, pretested questionnaire administered by trained research assistants. Clinical and biochemical data were extracted from the patient records and direct measurements. Blood pressure was measured using a calibrated sphygmomanometer after a 5-minute rest. Hypertension was defined as a systolic blood pressure ≥140 mmHg, a diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication. Diabetes mellitus was confirmed based on a fasting plasma glucose level of ≥126 mg/dL, HbA1c level of ≥6.5%, or current use of antidiabetic medication. Anthropometric measurements, including height and weight, were taken using standardized protocols, and BMI was calculated and classified according to the Asian cut-offs. Relevant complications, such as chronic kidney disease, ischemic heart disease, stroke, and diabetic retinopathy, were confirmed using medical records and clinical documentation. Demographic details were obtained through a structured interview. Informed consent was obtained from all participants. Confidentiality and anonymity were strictly maintained throughout the study period.

Statistical Analysis

Data were analyzed using IBM SPSS Statistics version 25.0. Descriptive statistics were used to summarize participant characteristics, expressed as mean ± standard deviation (SD) for continuous variables and frequency with percentage for categorical variables. Chi-square (χ²) tests were applied to compare categorical outcomes between groups, and p-values <0.05 were considered statistically significant.

Table 1: Baseline characteristics of the study participants (n = 250)

Table 1 presents the baseline sociodemographic and anthropometric characteristics of the participants. The mean age was 58.6 ± 9.4 years, with most participants aged between 55 and 64 years (38.0%). Males represented 52.0% of the sample. The mean body mass index (BMI) was 26.1 ± 3.8 kg/m², with 38.0% overweight and 26.0% obese based on Asian cut-offs. Urban residents accounted for 64.0% of participants, while 36.0% were from rural areas. Regarding educational attainment, 44.0% had primary education or less, 32.0% had secondary-level education, and 24.0% attained tertiary-level education. A total of 24.0% were current smokers.

Table 2: Distribution of hypertension and diabetes among study participants (n = 250)

Table 2 shows the distribution of HTN and DM among participants. Of the total, 38.0% had both conditions, while 28.0% had HTN alone and 20.0% had DM alone. Only 14.0% were free of either disease. This indicates a considerable overlap between HTN and DM in the studied population, reflecting the common coexistence of these chronic conditions in older adults attending clinical settings.

Table 3: Clinical parameters by comorbidity group

Table 3 describes key clinical parameters stratified by comorbidity status. Patients with both HTN and DM had the highest mean systolic blood pressure (155 ± 14 mmHg) and fasting blood glucose levels (182 ± 45 mg/dL). Their mean glycated hemoglobin (HbA1c) was 8.5 ± 1.4%, indicating suboptimal glycaemic control. Most individuals in this group were on both antihypertensive (84.2%) and antidiabetic therapy (89.5%). Median disease duration was longest in the dual-comorbidity group (8 years, IQR 4–13). Participants without either condition had the lowest blood pressure and glucose readings.

Table 4. Complications and obesity association among study participants

Table 4 summarizes the frequency of major complications and the association between obesity and comorbidity. Chronic kidney disease and ischemic heart disease were reported in 16.0% and 20.0% of all participants, respectively. Among diabetic patients, 41.4% had retinopathy. Prior stroke occurred in 4.8% of cases. Obesity (BMI ≥ 27.5 kg/m²) was significantly higher in participants with both HTN and DM (44.2%) compared to others (14.8%), showing a significant association (χ² = 8.72, p = 0.003).

This study explored the comorbidity profile of hypertension (HTN) and diabetes mellitus (DM) in middle-aged and elderly patients attending a tertiary care hospital in Bangladesh. The findings revealed a substantial coexistence of both conditions, with 38% of the participants affected by dual comorbidity. This prevalence is higher than community-based estimates but is consistent with other hospital-based studies conducted in South Asia, reflecting the increasing burden of these interlinked chronic conditions in clinical populations [14,15].

The predominance of dual comorbidity among older adults in this study was consistent with regional and global evidence. Advanced age contributes to vascular remodeling, insulin resistance, and metabolic dysregulation, which predispose individuals to both HTN and DM [5,6]. The mean age of 58.6 years in the current cohort aligns with previous studies in Bangladesh and India, which reported similar age ranges for the peak coexistence of these disorders [13,16]. The nearly equal sex distribution observed here contrasts with certain community-based studies that show a female predominance, possibly due to differences in health-seeking behaviour [17].

Obesity emerged as a strong determinant of comorbidity, significantly associated with the coexistence of HTN and DM. Nearly half of the participants with both conditions were obese, compared with only 15% among those with a single or no chronic disease. This finding supports established evidence that central adiposity and increased body mass index are key metabolic drivers for both hypertension and diabetes [5]. The mechanisms linking obesity to dual comorbidity include insulin resistance, sympathetic overactivity, and activation of the renin–angiotensin–aldosterone system, all of which contribute to vascular and glucose homeostasis abnormalities. Comparable findings have been reported in Indian and Sri Lankan populations, reinforcing the regional relevance of obesity as a shared risk factor [11].

Clinically, patients with concurrent HTN and DM had significantly higher mean systolic and diastolic blood pressures, elevated fasting glucose levels, and poorer glycaemic control (HbA1c >8%) compared to those with either condition alone. These results mirror the findings of Stratton et al., who reported that coexisting hypertension exacerbates insulin resistance and impairs endothelial function, leading to cumulative cardiovascular strain [7]. Despite a high proportion of these patients receiving antihypertensive and antidiabetic therapy, suboptimal control remained common, indicating potential issues of medication adherence or therapeutic inertia.

The burden of complications was notable among individuals with dual comorbidity. Chronic kidney disease (CKD), ischemic heart disease (IHD), and diabetic retinopathy were the most prevalent complications. Approximately one in five participants experienced IHD, while more than two-fifths of diabetic patients had retinopathy. These rates are comparable with earlier hospital-based studies in Bangladesh and India, which have documented accelerated microvascular and macrovascular complications in patients with both diseases [3,4]. The coexistence of HTN and DM is known to amplify endothelial damage, glomerular hyperfiltration, and atherosclerotic progression, resulting in compounded morbidity [1]. The finding of higher CKD prevalence in the dual-comorbidity group aligns with previous evidence demonstrating a synergistic effect of hyperglycemia and elevated blood pressure on renal impairment [9].

The predominance of urban residents (64%) in this study aligns with the findings of Alam et al., who reported that urbanization in Bangladesh is associated with sedentary lifestyles, increased dietary salt and fat intake, and higher chronic disease prevalence [11]. Moreover, the observed education pattern —nearly half with primary education or less—indicates the need for community-level awareness campaigns emphasizing preventive lifestyle modifications.

In summary, this study revealed that a considerable proportion of middle-aged and elderly patients in Bangladesh experience the dual burden of hypertension and diabetes, particularly among obese and urban individuals. The coexistence of these diseases is associated with poor control and a higher prevalence of renal, retinal, and cardiovascular complications. The findings emphasize the importance of adopting integrated chronic disease management and lifestyle modification programs to address the growing epidemic of metabolic comorbidities in the Bangladeshi healthcare system.

Limitations of the study

The single-center, cross-sectional design of this study limits its generalizability and causal inference. Laboratory confirmation was dependent on hospital records, and lifestyle variables, such as diet and physical activity, were not assessed. Despite these limitations, this study provides critical insights into the local comorbidity patterns of hypertension and diabetes.

This study demonstrated a high coexistence of hypertension and diabetes among middle-aged and elderly patients in a Bangladeshi clinical setting. Individuals with dual comorbidity exhibited poorer metabolic control, higher blood pressure, and a greater prevalence of complications, such as chronic kidney disease and ischemic heart disease. Obesity and urban residency were significant correlates of hypertension. These findings highlight the need for integrated screening, patient education, and long-term management strategies to address the increasing dual burden of hypertension and diabetes in resource-limited healthcare systems.

Acknowledgment

I would like to express my sincere gratitude for the invaluable support and cooperation provided by the staff, participants, and my co-authors/colleagues who contributed to this study.

Conflicts of interest

There are no conflicts of interest.

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