Clinical Profile and Antihypertensive Treatment Patterns in Patients with Comorbid Hypertension and Type 2 Diabetes Mellitus: Insights from the National Hypertension Registry

Relevance. The high prevalence of diabetes mellitus among patients with hypertension and the increased risk of cardiovascular complications necessitate a more detailed study of the characteristics of this patient group in order to optimize their management approach.

Objective. To identify clinical features of comorbid patients with hypertension and diabetes mellitus, as well as to assess their treatment.

Materials and methods. 57396 ambulatory patients from the national registry of hypertension were included in this study. They were divided into 2 groups based on the presence of absence of diabetes mellitus. The assessment of social and anthropometric factors, medical history, modifiable cardio-vascular risk factors was conducted. Statistical analysis was done using R 4.3.3 environment (R foundation for Statistical Computing, Vienna, Austria).

Results. Type 2 diabetes mellitus (T2DM) was detected in 15.3% of patients with hypertension (HTN). The group of patients with HTN and type 2 diabetes mellitus was predominantly represented by women (66.6%), who most often had risk factors such as obesity (55.4%) and low physical activity (40.3%). Compared to hypertensive patients without T2DM, those with hypertension and T2DM had significantly higher rates of chronic heart failure (64.4% vs 46.0%), coronary artery disease (54.9% vs 39.0%), chronic kidney disease (35.8% vs 28.3%), and prior cerebrovascular events (7.0% vs 4.1%). Patients with hypertension combined with T2DM demonstrated greater treatment resistance, with more frequent prescriptions of angiotensin receptor blockers (24.7% vs 16.7%), beta-blockers (59.5% vs 51.5%), and calcium channel blockers (22.3% vs 15.1%).

Conclusions. The identified changes reflect an additional negative impact of type 2 diabetes on the course of hypertension and the development of cardiovascular complications. Due to the high burden of cardiac and non-cardiac pathologies in this patient group, a more aggressive and multicomponent approach to therapy is required. The obtained results emphasize the need for the development of comprehensive programs for prevention, early diagnosis, and an individualized approach to prescribing therapy. The combination of hypertension and type 2 diabetes in the Russian federation necessitates an interdisciplinary approach with an emphasis on controlling metabolic parameters and the early prevention of complications.

1. Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010

2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389(10064):37-55. https://doi.org/10.1016/S0140-6736(16)31919-5

3. Balanova Yu.A., Drapkina O.M., Kutsenko V.A. et. al. Hypertension in the Russian population during the COVID-19 pandemic: sex differences in prevalence, treatment and its effectiveness. Data from the ESSERF3 study. Cardiovascular Therapy and Prevention. 2023;22(8S):3785. (In Russ.) EDN: YRUNUX. https://doi.org/10.15829/1728-8800-2023-3785

4. Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31. (In Russ.) https://doi.org/10.26442/2075082X.2019.1.190179

5. Dedov I.I., Shestakova M.V., Mayorov A.Yu et. al. 10th edition. Diabetes mellitus. 2021;24(1S):1-148. (In Russ.) https://doi.org/10.14341/DM12802

6. Dedov I.I., Shestakova M.V., Galstyan G.R. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes mellitus. 2016;19(2):104-112. (In Russ.) https://doi.org/10.14341/DM2004116-17

7. Zhernakova Yu.V., Chazova I.E., Oshchepkova E.V. et al. The prevalence of diabetes mellitus in population of hypertensive patients according to ESSE RF study results. Systemic Hypertension. 2018;15(1):56-62. (In Russ.) https://doi.org/10.26442/2075-082X_15.1.56-62

8. Wang Z, Yang T, Fu H. Prevalence of diabetes and hypertension and their interaction effects on cardiocerebrovascular diseases: a cross-sectional study. BMC Public Health. 2021;21(1):1224. Published 2021 Jun 25. https://doi.org/10.1186/s12889-021-11122-y

9. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755-1762. https://doi.org/10.1016/s0140-6736(98)04311-6

10. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119

11. Nazarzadeh M, Bidel Z, Canoy D, et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet. 2021;398(10313):1803-1810. https://doi.org/10.1016/S0140-6736(21)01920-6

12. Virani S.S., Alonso A., Aparicio H.J. et al. Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254–e743. https://doi.org/10.1161/CIR.0000000000000950

13. Federal State Statistics Service (Rosstat). Life Expectancy in 2023. (In Russ.)https://rosstat.gov.ru/storage/mediabank/Demogr_ejegod_2023.pdf

14. Shestakova M.V., Vikulova O.K., Zheleznyakova A.V., et al. Diabetes epidemiology in Russia: what has changed over the decade? Therapeutic Archive. 2019;91(10):4–13. https://doi.org/10.26442/00403660.2019.10.000364

15. IDF DIABETES ATLAS, 10th edition Dianna J. Magliano, Co-chair, Edward J. Boyko, Co-chair; IDF Diabetes Atlas 10th edition scientific committee. Brussels: International Diabetes Federation; 2021. Publication No.: book_idfatlas10e ISBN-13: 978-2-930229-98-0

16. Kalil GZ, Haynes WG. Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications. Hypertens Res. 2012;35(1):4-16. https://doi.org/10.1038/hr.2011.173

17. Aksenova A.V., Oshchepkova E.V., Orlovskii A.A., Chazova I.E. Gender-age peculiarities of smoking and diabetes mellitus role in the development of myocardial infarction in patients with arterial hypertension. Systemic Hypertension. 2020;17(4):24-31. (In Russ.) https://doi.org/10.26442/2075082X.2020.4.200245

18. Fagard RH. Smoking amplifies cardiovascular risk in patients with hypertension and diabetes. Diabetes Care. 2009;32 Suppl 2(Suppl 2):S429-S431. https://doi.org/10.2337/dc09-S354

19. Brož J, Malinovská J, Nunes MA, et al. Prevalence of diabetes and prediabetes and its risk factors in adults aged 25-64 in the Czech Republic: A cross-sectional study. Diabetes Res Clin Pract. 2020;170:108470. https://doi.org/10.1016/j.diabres.2020.108470

20. Liu M, Zhang W, Yan Z, Yuan X. Smoking increases the risk of diabetic foot amputation: A meta-analysis. Exp Ther Med. 2018;15(2):1680-1685. https://doi.org/10.3892/etm.2017.5538

21. Jiang N, Huang F, Zhang X. Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies. Oncotarget. 2017;8(54):93209-93218. Published 2017 Oct 4. https://doi.org/10.18632/oncotarget.21478

22. Barengo NC, Teuschl Y, Moltchanov V, Laatikainen T, Jousilahti P, Tuomilehto J. Coronary heart disease incidence and mortality, and all-cause mortality among diabetic and non-diabetic people according to their smoking behavior in Finland. Tob Induc Dis. 2017;15:12. Published 2017 Feb 2. https://doi.org/10.1186/s12971-017-0113-3

23. Millett ERC, Peters SAE, Woodward M. Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants. BMJ. 2018;363:k4247. Published 2018 Nov 7. https://doi.org/10.1136/bmj.k4247

24. Fox CS, Larson MG, Leip EP, et al. Diabetes and the Risk of Stroke: The Framingham Study. Circulation. 2002;106 (Suppl II):II-818.

25. Kagan A, Dawber TR, Kannel WB, Revotskie N. The Framingham study: a prospective study of coronary heart disease. Fed Proc. 1962 Jul-Aug;21(4)Pt 2:52-7. PMID: 14453051.

26. UK Prospective Diabetes Study (UKPDS). VIII. Study design, progress and performance. Diabetologia. 1991;34(12):877-890.

27. Aksenova A.V., Yelfimova Ye.M., Galitsin P.V., Goriyeva Sh.B., Bugayev T.D., Mikhailova O.O., Litvin A.Yu., Rogoza A.N., Chazova I.Ye. Role of the Pulse Oximetry in the cardiologist's practice. Systemic Hypertension. 2014;11(4):26-30. (In Russ.)

28. Esmaeili N, Gell L, Imler T, et al. The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults. EClinicalMedicine. 2025;83:103221. Published 2025 Apr 23. https://doi.org/10.1016/j.eclinm.2025.103221

29. Lecube A, Simó R, Pallayova M, et al. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev. 2017;38(6):550-573. https://doi.org/10.1210/er.2017-00173

30. A Tahrani A. Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes. Eur Endocrinol. 2015;11(2):81-89. https://doi.org/10.17925/EE.2015.11.02.81

31. Collier A, Stirling A, Cameron L, Hair M, Crosbie D. Gout and diabetes: a common combination. Postgrad Med J. 2016;92(1089):372-378. https://doi.org/10.1136/postgradmedj-2015-133691

32. McAdams-DeMarco MA, Maynard JW, Baer AN, Coresh J. Hypertension and the risk of incident gout in a population-based study: the atherosclerosis risk in communities cohort. J Clin Hypertens (Greenwich). 2012;14(10):675-679. https://doi.org/10.1111/j.1751-7176.2012.00674.x

33. Kim SC, Liu J, Solomon DH. Risk of incident atrial fibrillation in gout: a cohort study. Ann Rheum Dis. 2016;75(8):1473-1478. https://doi.org/10.1136/annrheumdis-2015-208161

34. Kadayifci A, Tan V, Ursell PC, Merriman RB, Bass NM. Clinical and pathologic risk factors for atherosclerosis in cirrhosis: a comparison between NASH-related cirrhosis and cirrhosis due to other aetiologies. J Hepatol. 2008;49(4):595-599. https://doi.org/10.1016/j.jhep.2008.05.024

35. Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019;71(4):793-801. https://doi.org/10.1016/j.jhep.2019.06.021

36. Brown MJ, Castaigne A, de Leeuw PW, Mancia G, Rosenthal T, Ruilope LM. Study population and treatment titration in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT). J Hypertens. 1998;16(12 Pt 2):2113-2116.

37. Blinova N.V., Aksenova A.V., Podzolkov V.I., Tarzimanova A.I., Ambatiello L.G., Chazova I.E. Medical Society of Hypertension. Use of beta-blockers in patients with hypertension. Systemic Hypertension. 2025;22(3):5-18. (In Russ.) https://doi.org/10.38109/2075-082X-2025-3-5-18

38. Chen R, Suchard MA, Krumholz HM, et al. Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension. 2021;78(3):591-603. https://doi.org/10.1161/HYPERTENSIONAHA.120.16667

39. Mohammad A., Abujbara M., Alshraideh J., Jaddou H., Ajlouni K. The Prevalence of Resistant Hypertension Among Type 2 Diabetic Patients Attending the National Center for Diabetes, Endocrinology, and Genetics. J Endocrinol Metab. 2017;7(5):153-158. https://doi.org/10.14740/jem448e

40. Narkiewicz K, Kjeldsen SE, Egan BM, Kreutz R, Burnier M. Masked hypertension in type 2 diabetes: never take normotension for granted and always assess out-of-office blood pressure. Blood Press. 2022;31(1):207-209. https://doi.org/10.1080/08037051.2022.2107483

41. Mancia G, Kreutz R, Brunstrom M, et. al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Dec 1;41(12):1874-2071. https://doi.org/10.1097/HJH.0000000000003480. Epub 2023 Sep Erratum in: J Hypertens. 2024 Jan 1;42(1):194. PMID: 37345492. https://doi.org/10.1097/HJH.0000000000003621

42. Grodzinsky A, Kosiborod M, Tang F, et al. Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus. Circ Cardiovasc Qual Outcomes. 2017;10(9):e003553. https://doi.org/10.1161/CIRCOUTCOMES.117.003553

43. Eckel RH, Bornfeldt KE, Goldberg IJ. Cardiovascular disease in diabetes, beyond glucose. Cell Metab. 2021;33(8):1519-1545. https://doi.org/10.1016/j.cmet.2021.07.0