Diabetes mellitus (DM) and hypertension (HTN) are two of the most common non-communicable diseases in the globe and major challenges to public health as they are chronic, come with a lot of complications, and a huge economic burden.[1] Both conditions are high risk factors of cardiovascular diseases, stroke, chronic kidney disease, and early death.[2] The combination of diabetes and hypertension is of special concern, as they have in common obesity, sedentary lifestyle, poor dieting, aging, and genetic susceptibility, and together contribute to the accelerated development of end-organ damage.[3]

Diabetes has become very common globally in the last few decades. The international estimates indicate that over 500 million adults have diabetes and the number is expected to grow significantly in the next several years, especially in the low and middle-income countries.[4] Hypertension is a disease that afflicts more than a billion adults across the globe and it is one of the most significant risk factors of morbidity and mortality of cardiovascular diseases that are subject to modification.[5] Worryingly, a major percentage of patients with hypertension are either not diagnosed or are poorly treated and this worsens the chances of developing negative health consequences. The burden of diabetes and hypertension is also on the rise in adults and this compounded the health care system.[6]

The rate at which both diabetes mellitus and hypertension are increasing in South Asian countries, including Pakistan, is alarming because of the rapid urbanization, sedentary lifestyles, change in diets, and access to preventive healthcare services.[7, 8] According to epidemiological research, adults in the region are diagnosed with them at an earlier age than that of western populations, and the disease duration and prevalence of complications are quite long.[9, 10] With this increasing burden, a significant population may not be aware of their disease status indicating that population-based screening and surveillance are important.

Determining the prevalence of diabetes mellitus and hypertension among adult populations is critical to determine the extent of the diseases, the populations at high risk, and evidence-based approaches to improving the health of the population. Cross-sectional research is also critical in the development of baseline epidemiological statistics particularly in resource constrained institutions where there might be no total national surveillance systems in place.

Nonetheless, local and regional statistics regarding the co-occurrence of diabetes and hypertension in adults are inadequate in most of the regions. Since diabetes mellitus and hypertension have increased burden and common risk factors, there is an urgent necessity to establish their prevalence in adult population to support the early detection and prevention measures. It was thus decided to undertake this study to establish the prevalence of diabetes mellitus and hypertension in adults by using a cross-sectional design, with an objective of establishing baseline data that can guide the planning of health programs, screening programs and specific interventions to be undertaken to reduce morbidity and mortality as a result of the disease.

This was a cross-sectional study carried out to establish the prevalence of diabetes mellitus and hypertension among the adult population. The research was conducted at outpatient departments and community environments. The time frame of data collection was one year between, to guarantee the sufficient representation of the adult population and reduce the impact of seasonal factors on healthcare usage. The OpenEpi (Version 3) software was used to calculate the sample size and is an open-source epidemiological statistics package. Taking 50% as the assumed prevalence of diabetes mellitus and hypertension,[11] a 95% confidence level, a 5% margin of error, the minimum sample size was calculated based on the formula of single population proportion: Where Z = 1.96 to represent 95% level of confidence, p = 0.50, and d = 0.05. The total calculated sample was 384 participants. The sample size was adjusted at 10% higher to ensure that non-response and incomplete data are factored off and therefore the final sample size was about 422 participants A non-probability consecutive sampling methodology was used. All qualified adult persons who reported at the time of the study and fit the inclusion criteria were contacted one after another until the desired sample size was reached. This method was selected because it was feasible in a community and clinical-based environment and the prevalence studies. Male and female adults aged 18 years and above and those who lived within the study area and were ready to participate in the study by giving informed consent were eligible to join the study. Those participants who had known history of diabetes mellitus or hypertension and those who were diagnosed during the screening process were also included. Pregnant people, those who were critically ill and could not communicate as well as those who did not want to take part were not included. The patients who had secondary causes of hypertension or diabetes as a result of endocrine diseases, chronic steroid users, and those with severe systemic illness were also eliminated to prevent confounding. The processes of data collection involved the administration of a structured, pre-tested questionnaire, face-to-face interviews conducted by the trained data collectors. The questionnaire was divided into a socio-demographic (age, gender, education, occupation), lifestyle (physical activity, smoking status) and medical history (diabetes mellitus and hypertension). A standardized calibrated sphygmomanometer was used to measure blood pressure. The measurements were recorded in a sitting position with more than five minutes rest period. The two readings were taken after every five minutes and the average calculated. The criterion of hypertension was determined by the general guidelines as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or the use of antihypertensive drugs. Random blood glucose levels were measured by a glucometer under the guidance of aseptic conditions to assess diabetes mellitus. Those with a random blood glucose ≥200mg/dL and having the symptoms or having a history of diabetes were considered diabetic. Known cases were those who were already on antidiabetic drugs. Each measurement was made using standard operating procedures to provide reliability and validity of data. The analysis of the data was performed by the use of Statistical Package of Social Sciences (SPSS) 24. The data was summarized using descriptive statistics. Continuous variables like age and blood pressure were given in the form of the mean ± standard deviation whereas the categorical variables were in the form of frequencies and percentages. The frequency of diabetes mellitus and high blood pressure was estimated using 95% confidence interval. The Chi-square test or Fisher exact test, where necessary, were used to determine associations between socio-demographic variables and the occurrence of diabetes and hypertension. The p-value below 0.05 was held to be statistically significant.

The number of adult participants was 422. The average age of the respondents was 44.6 ± 13.8, with a just insignificant deviation towards the female gender (53.6%). The age range was 31-60 years (63%), and the majority of the respondents were living in urban regions (56.4%). On the issue of education, 29.4% were illiterate with 20.4% having graduated or higher (Table 1).

The general level of diabetes mellitus among the study population was 29.9% and hypertension was 37.4% in the participants. Moreover, 21.8% of participants were infected by diabetes and hypertension, and 40.3% were not infected by any of these non-communicable diseases, which means that the burden of the latter in adults is considerable (Table 2).

When the analysis of diabetes mellitus was done according to the socio-demographic variables, it was noted that the older the age of the people the higher the prevalence. Dia was only statistically significant in age with 10.3% of those with diabetes aged 18-30 years, 43.5% aged 46-60 years, and 41% aged 60 years and above (p < 0.001). There was no significant difference between the level of diabetes and gender and education level (Table 3).

Age also exhibited a very clear pasture in hypertension. The hypertension rate was 12.8% amongst individuals aged 18-30 years and 50% and 56.4% among individuals aged 46-60 years and over 60 years respectively. Hypertension was slightly more prevalent in male participants (41.8% vs 33.6% in females) and the difference was statistically significant (p = 0.041). The other variables did not significantly correlate with hypertension e.g. education and residence (Table 4).

Diabetes mellitus was observed to be predominant among urban residents as opposed to rural participants (34.5% vs 23.9% p = 0.018), however hypertension did not exhibit any statistically significant difference between urban and rural residents (Table 5).

The co-occurrence of diabetes and hypertension was analyzed to show that the prevalence of the two in co-occurrence tended to rise with age. The prevalence of both conditions was only 2.6% among participants aged between 18-30 years as opposed to 41% among those over 60 years indicating significant age-related change in the risk of concurrent diabetes and hypertension is increased (p < 0.001) (Table 6).

Table 1: Socio-Demographic Characteristics of Study Participants (n = 422)

Table 2: Prevalence of Diabetes Mellitus and Hypertension Among Participants

Table 3: Distribution of Diabetes Mellitus According to Socio-Demographic Variables

Table 4: Distribution of Hypertension According to Socio-Demographic Variables

Table 5: Association of Diabetes Mellitus and Hypertension with Residence

Table 6: Co-existence of Diabetes Mellitus and Hypertension by Age Group

In the current investigation, diabetes mellitus was widespread among adult respondents: 29.9%, and hypertension in 37.4% of the participants, 21.8% were both comorbid. The implications of these findings are that there was a large proportion of cardiometabolic conditions in the study population comprising of adults and their prevalence was more as people were older and lived in urban areas. The urban preponderance in adults is consistent with other epidemiological trends observed within various populations.

Observed in the recent literature, a number of studies show the same or divergent prevalence rates, which are based on population characteristic differences and methodology. Indicatively, a community-based survey of young adults (18-35 years) in 2025 reported lower prevalence of diabetes (7.3%) and hypertension prevalence (18.4%) in younger populations with age being a key determinant of disease burden in most settings, with prevalence of both diseases high among older adults compared to younger populations.[12]

Cohort studies on a large scale conducted in Tabari cohort in Northern Iran indicated that the prevalence of undiagnosed hypertension and diabetes were 5% and 4.7%, respectively, in what appeared to be a healthy population, which was lower than our study that may be because the inclusion age groups and the definition of screening are not similar.[13]

There are also increasing trends in the prevalence of diabetes seen globally in comparison. According to a cross-national study of general populations in 2019 to 2022, the prevalence of diabetes was rising by an average of 7.76% to 8.49% but the prevalence of hypertension did not change significantly. Such a pattern of rising diabetes indicates a world trend but at far lower rates as a proportion of the population as compared to our cohort of adults where nearly one out of every three adults had diabetes.[14]

High disease burden is also reported in literature in regions in South Asia and such environments. The pre-diabetes or diabetes comorbidity among hypertensive patients was approximately 20.5% in a rural South Asian cohort with prediabetes or diabetes comorbidity being over 50% in some rural examinations which indicates the common co-occurrence of these ailments.[15] Moreover, a South Punjab, Pakistan based study indicated that prevalence of diabetes in adults was 26.7% similar to our results, but, as a secondary measure, the precise prevalence of hypertension was not the target of the analysis.[16]

Conversely, screenings in urban centers like Ahmedabad on a community level have reported initial indications of 29% hyperglycemia and 35% hypertension indicating very similar prevalence rates to ours and indicating similar health burdens in the urban areas.[17] Similarly, health surveys of Indian population also show that about 20% of adults over 30 years of age have diabetes, hypertension or both but the numbers differ broadly depending on the setting and age structure of the population.[18]

Further studies concerning a particular group of comorbidities also confirm the high incidence of diabetes and hypertension in our cohort. A study of type 2 diabetes patients in Afghanistan has cited a hypertension prevalence that was above 55% indicating that diabetic populations stand high chances of elevating their blood pressure levels.[19] Similarly, systematic reviews in Southeast Asian studies reported prevalence of hypertension among adults with diabetes that were routinely at or above 70%, but the study settings varied (were not general population of adults).[20]

Conversely, the absolute prevalence rates of diabetes and hypertension in adult populations are lower in cross-sectional studies in Western or high-income areas. To illustrate, national studies in sections of Europe and North America have recorded diabetes prevalence at less than 15% with associated hypertension rates having differences in terms of lifestyle and health systems.[14]

The trends within the current research can be associated with the growing age-related cardiometabolic disease in numerous studies. As many cohort and population studies indicate, age has been one of the most reliable predictors of diabetes and hypertension in the whole world. The young people generally experience fewer cases, whereas middle-aged and the elderly are witnessing significant proportions of growth due to cumulative risks of lifestyle changes and metabolic imbalances.[12]  Additionally, we have found that disease is more common in urban inhabitants which is supported by literature that has argued that urbanization, sedentary living and dietary changes are associated with the increased burden of non-communicable diseases in low and middle income nations with urban living conditions most likely to promote lifestyle risk factors.[21]

In short, differing population age, urban/rural location, diagnostic threshold, and healthcare access cause varying prevalence estimates to be found across the research; however, the high rate of diabetes and hypertension in this study is consistent with regional and global patterns of rising cardiometabolic disease. The findings indicate the necessity of early screening, prevention, and specific interventions, especially in older and urban adult populations where the prevalence of diseases is the greatest.

There are a number of clinical and public health implications of the findings of this study. The prevalence of diabetes mellitus and hypertension especially in adults of older age and urban setting highlights the necessity of the routine screening programs in the community and primary care. Long-term complications (cardiovascular disease, stroke, and chronic kidney disease) are preventable by early detection of these conditions. Clinicians ought to understand the high risk of the presence of both diabetes and hypertension that require comprehensive management approaches, such as lifestyle change, medication, and patient education. In addition, the high correlation of these conditions with age and living in urban areas.

This research is limited in a number of ways. As a cross-sectional design, it offers prevalence data, but it does not allow establishing causal links between socio-demographic variables and the occurrence of the disease. Consecutive sampling could be a source of selection bias and act of restriction to the general population of adults in outpatient and community setting. Also, diabetes screening (random blood glucose) was employed in place of fasting plasma glucose or HbA1c, which could underestimate or overestimate actual prevalence. The self-reported lifestyle factors and family history made their way, which creates the risk of recall bias. 

The research indicates that diabetes mellitus and hypertension are very common among adults, and a good percentage of adults have both diseases simultaneously. Increased risk was related to older age, male gender and urban residence. Such results indicate the necessity of screening, early diagnosis and combination of management methods to avoid complications. Lifestyle modification and awareness programs are important in the context of public health interventions that reduce the burden of these chronic diseases in adult populations.

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