Abstract
The risk of cardiovascular diseases (CVDs) is significantly increased when diabetes mellitus and hypertension coexist. Improving the clinical management of people with hypertension requires understanding the prevalence of diabetes in these patients. We conducted a cross-sectional analysis of 5,935 adults with hypertension who participated in the STEPwise approach to non-communicable diseases (NCD) risk factor surveillance (STEPS) 2021 of Iran. Diabetes mellitus was defined as fasting plasma glucose ≥ 126 mg/dL or current use of anti-hyperglycemic medication. Prediabetes was defined as 100 ≤ FPG < 126 without current anti-hyperglycemic medication use. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or a history of anti-hypertensive treatment. Using logistic regression, we found characteristics associated with diabetes prevalence, while linear regression assessed the impact of diabetes status on systolic and diastolic blood pressure. Survey weights were utilized to ensure representativeness. Among individuals with hypertension, 25.3% (95% CI: 23.69–26.92) had diabetes, and 29.7% (95% CI: 27.93–31.45) had prediabetes. Of the diabetic patients, 20.7% achieved good glycemic control, 50.3% had uncontrolled diabetes, 7.8% were untreated, and 21.2% were undiagnosed. Diabetes was significantly more prevalent in those with cardiovascular disease (adjusted odds ratio (AOR) = 1.45, 95% CI: 1.14–1.84), chronic renal disease (1.74, 1.42–2.14), and dyslipidemia (1.83, 1.23–2.72). A positive family history of diabetes was significantly strong predictor (3.06, 2.53–3.69). Older age, urban residency, higher waist circumference, better diet quality, and hypertension treatment were also associated with increased diabetes risk. DBP was significantly lower in individuals with controlled diabetes (expected mean difference (EMD)= -2.52, 95% CI: -4.6 to -0.44) and treated but uncontrolled diabetes (EMD − 2.13, -3.77 to -0.48), while SBP was significantly higher in individuals with undiagnosed diabetes (EMD 4.76, 0.28–9.24). Diabetes and prediabetes are common among people with hypertension, with significant gaps in glycemic control. Early detection and improved management of both blood pressure and blood sugar levels are essential to reduce the burden of CVDs. Public health initiatives must prioritize targeted interventions for high-risk groups to effectively enhance diabetes management among individuals with hypertension.
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Data availability
The data of this study are available from the corresponding author on reasonable request.
Abbreviations
- ACE:
-
Angiotensin-Converting Enzyme
- ARB:
-
Angiotensin Receptor Blocker
- AOR:
-
Adjusted Odds Ratio
- BMI:
-
Body Mass Index
- CKD:
-
Chronic Kidney Disease
- CI:
-
Confidence Interval
- CVDs:
-
Cardiovascular Diseases
- CHD:
-
Coronary Heart Disease
- DBP:
-
Diastolic Blood Pressure
- DPP-4:
-
Dipeptidyl Peptidase-4
- eGFR:
-
Estimated Glomerular Filtration Rate
- EMD:
-
Expected mean difference
- FBS:
-
Fasting Blood Sugar
- FPG:
-
Fasting Plasma Glucose
- GLP-1 RA:
-
Glucagon-Like Peptide-1 Receptor Agonist
- HbA1c:
-
Glycosylated Hemoglobin
- HDL-C:
-
High-Density Lipoprotein Cholesterol
- HTN:
-
Hypertension
- LDL-C:
-
Low-Density Lipoprotein Cholesterol
- MR:
-
Mendelian Randomization
- NCD:
-
Non-Communicable Diseases
- NCEP ATP III:
-
National Cholesterol Education Program, Adult Treatment Panel III
- OGTT:
-
Oral Glucose Tolerance Test
- SBP:
-
Systolic Blood Pressure
- SGLT2-i:
-
Sodium-Glucose Cotransporter-2 Inhibitor
- TC:
-
Total Cholesterol
- TG:
-
Triglycerides
- UACR:
-
Urine Albumin-to-Creatinine Ratio
- WHO:
-
World Health Organization
- GPAQ:
-
Global Physical Activity Questionnaire
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Acknowledgements
This study was supported by I.R. Iran’s National Institute of Health Research, Tehran University of Medical Sciences, Iran. Contract NO: 241/M/9839. The authors wish to convey their appreciation to the Deputy of Research and Technology, the Deputy of Health at the Ministry of Health and Medical Education, the National Institute of Health Research, the World Health Organization, and numerous other scholars and experts in pertinent fields. Furthermore, we express our gratitude to all participants, as well as the scientific and executive collaborators from several medical research colleges who facilitated this event. The authors express their gratitude to the workers of the Non-Communicable Diseases Research Center of the Endocrinology and Metabolism Population Sciences Institute of Tehran University of Medical Sciences, especially Dr. Yosra Azizpour, for their unwavering collaboration.
Funding
Grant IDs 1403-2-221-73074 from the Endocrinology and Metabolism Population Sciences Institute at Tehran University of Medical Sciences in Tehran, Iran, funded this study. No part of the study’s planning, execution, analysis, or manuscript preparation was influenced by the funders.
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Conceptualization: O.T.-M., M.M., A.G., S.K.; Methodology: M.M., A.G., S.K., O.T.-M.; Formal analysis: M.M., A.G.; Investigation: N.R., M.M., A.G., S.K.; Resources: O.T.-M., N.R.; Data Curation: M.M., A.G.; Validation: M.M., A.G., 0.T.-M., N.R., N.P., M.L.; Writing - Original Draft: M.M., A.G.; Writing - Review and Editing: M.M., A.G., O.T.-M., S.K., N.R., N.P, M.L.; Supervision: O.T.-M.; Project administration: O.T.-M.; Funding acquisition: O.T.-M. All authors have reviewed and approved the final version of the manuscript.
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Proposal of the current study was approved by the Ethical Committee of Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.EMRI.REC.1403.071).
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Mirzad, M., Golestani, A., Khosravi, S. et al. Prevalence of diabetes/prediabetes and their associated risk factors among adults with hypertension from iran: a nationwide study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-35998-1
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DOI: https://doi.org/10.1038/s41598-026-35998-1


