Abstract Body: Introduction: Hypertension (HTN) and type 2 diabetes (T2D) prevalence is on the rise resulting in an increasing number of US adults living with multiple cardiometabolic morbidities. The association of co-existing HTN and T2D with mortality risk has not been quantified.

Hypothesis: Co-existing HTN and T2D are associated with higher all-cause and cardiovascular mortality risk compared to having either condition alone or neither condition, and associations vary by sex, race and ethnicity.

Methods: Participants were 48,727 adults from the 1999-2018 National Health and Nutrition Examination Surveys (NHANES). Blood pressure and glycemic indicators were used to categorize participants into 4 groups: 1) neither condition, 2) HTN only, 3) T2D only, 4) co-existing HTN and T2D. Mortality was ascertained using the National Death Index. Kaplan-Meier curves and multivariable Cox proportional hazards models evaluated associations with mortality.

Results: Overall, 50.1% of participants had neither condition, 38.4% had hypertension alone, 2.8% had T2D alone, and 8.7% had both. During a median follow up of 9.2y, there were 7,734 total deaths, of which 2,013 were CVD deaths. Compared to having neither condition, co-existing HTN and T2D were associated with >2-fold and ~3-fold higher all-cause and CVD mortality risk (HR(95%CI): 2.46 (2.45, 2.47) and 2.97 (2.94, 3.00), respectively). Compared to having T2D or HTN only, co-existing T2D and HTN status was associated with up to 82% and 93% higher all-cause and CVD mortality risk. In stratified analyses, associations were stronger in females vs. males (p-interaction<0.01), and differential associations were observed by race and ethnicity (p-interaction<0.01) (Figure).

Conclusions: The co-existence of HTN and T2D substantially increases all-cause and CVD mortality risk. Findings underscore the critical need for multilevel contextual interventions that address multiple cardiometabolic morbidities to extend lifespan and address chronic disease inequities in the US population.