New Delhi: Indians diagnosed with either diabetes or hypertension after the age of 40 should routinely be screened for the other condition, according to a new study that found the two diseases increasingly occur together from middle age onwards.
Published Saturday in Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal, the study analysed electronic health records of over 56,000 adults.
While doctors have long known that diabetes and hypertension often occur together, the study adds an age-wise picture of when that overlap begins to rise sharply in Indians, and puts a number on how strongly the two diseases are linked.
The researchers found that the coexistence of diabetes and hypertension starts increasing rapidly around the age of 40, continues climbing until the late 50s, and then slows before levelling off around 70. Nearly one in 20 adults in the study had both conditions.
“Our primary focus was to determine how common the coexistence of hypertension and diabetes is among Indian adults, which we found to be around 5 percent,” Dr Abhaya Indrayan, from the Department of Clinical Research at Max Healthcare, New Delhi, and the study’s lead author, told ThePrint.
He said the coexistence was “almost nil in the younger age” but increased steadily from there.
The study also calculated what the authors call a “synergy factor”—a measure of how much more often the two diseases occur together than would be expected by chance.
“If they were completely independent diseases, they would occur together much less often. What we found is that they coexist about two times more than expected. Hypertension promotes diabetes and diabetes promotes hypertension because they share several underlying risk factors,” Dr Indrayan said.
India has one of the world’s largest burdens of both diseases. An Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study estimates that 101 million Indians have diabetes and 315 million have hypertension.
Globally, around 830 million people live with diabetes and 1.4 billion with hypertension, according to the World Health Organization.
“We should stop thinking of diabetes and hypertension as two separate diseases. In many Indians, they start and co-exist together,” Dr Anoop Misra, chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences in New Delhi, told ThePrint.
“Detecting one should automatically trigger screening for the other. Waiting for symptoms of the second condition means we may lose valuable time to prevent heart disease, stroke and kidney damage,” he added.
‘Large cohort’
The study by Max Healthcare researchers examined the health records of 56,393 adults who underwent preventive health check-ups at six hospitals across Delhi-NCR between 2021 and 2024.
“This is a large cohort for such a study on concurrent prevalence,” said Dr Indrayan.
Participants were classified as having diabetes if they were already on treatment, or if a blood test called HbA1c—which shows the average blood sugar level over the past two to three months—was 6.5 percent or higher, or if fasting blood sugar was 126 mg/dL or higher.
Hypertension was defined as being on treatment for it, or having a blood pressure reading of 140/90 mmHg or higher.
Overall, 20.9 percent of participants had diabetes and 11.4 percent had hypertension. Nearly 4.9 percent had both.
Pattern seen well beyond India
If diabetes and hypertension developed independently of each other, the researchers estimate their overlap would have been only about half as large. Instead, the double burden exists almost twice as often as expected by chance.
Researchers say this pattern points toward shared biological drivers such as obesity, insulin resistance, chronic inflammation, physical inactivity and abnormalities in blood vessel function, rather than the two diseases simply appearing side by side by coincidence.
The findings echo a broader global pattern.
A 2021 review published in the American Heart Association journal Hypertension described diabetes and hypertension as feeding into each other through shared biological pathways. Insulin resistance and diabetes predispose people to high blood pressure and vascular stiffness, while that same arterial stiffness worsens insulin resistance in turn.
The authors pointed to overlapping drivers such as inflammation, oxidative stress and blood vessel dysfunction as core to why the two conditions travel together.
A separate US analysis by researchers at Columbia University’s Mailman School of Public Health, published in Diabetes Care, used two decades of national health survey data (1999–2018) and found that the share of American adults with both hypertension and type 2 diabetes roughly doubled over that period, from 6 percent to 12 percent.
About two-thirds of adults with diabetes in the study also had hypertension, and about a quarter of those with hypertension also had diabetes.
According to Dr Ashok Kumar Jhingan, Senior Director at the Centre for Diabetes, Thyroid, Obesity and Endocrinology at BLK Max Hospital in New Delhi, the findings reinforce the need to move beyond treating diabetes as a disease of blood sugar alone.
“As a clinician managing complex metabolic disorders daily, the study underscores a vital truth in contemporary endocrinology: Type 2 diabetes cannot be treated in isolation,” he said.
He added that people with diabetes frequently go on to develop heart and kidney complications.
“In clinical practice, managing diabetes requires us to look far beyond glycaemic (blood sugar) control. Early screening, aggressive blood pressure management, lipid optimisation and the timely use of organ-protective therapies are indispensable to preventing end-stage renal and cardiac outcomes,” Dr Jhingan said.
(Edited by Nida Fatima Siddiqui)
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