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.