A tremendous increase in the coexistence of diabetes and hypertension has been observed recently in India. Apart from lifestyle and genetic factors, socioeconomic status, age, gender, occupation and lack of awareness are also contributing to the tremendous increases in the prevalence of both the diseases. Hypertension has been long recognised as one of the major risk factors for chronic disease burden, morbidity and mortality in India, attributable to 10.8% of all deaths in the country. Even though microvascular complications are frequently linked to hyperglycaemia, studies have also proven the critical involvement of hypertension in the development of these co-morbidities. The co-occurrence of hypertension in diabetic patients considerably escalates the risks of coronary heart disease, stroke, nephropathy and retinopathy. The annual expenditure for diabetes for the Indian population was estimated to be 1541.4 billion INR ($31.9 billion) in 2010. The expense of diabetes care further escalates in the presence of complications or co-morbidities. Generally, a diabetic patient with hypertension spent an average of 1.4 times extra than a diabetic patient without hypertension. Even though diabetes and hypertension are considered as important risk factors for cardiovascular and chronic kidney diseases, the awareness about the prevention, treatment and control of these diseases remains alarmingly low in the developing countries like India. The healthcare system in India should focus on better hypertension screening and control, especially in diabetic patients, to minimise the burden of the dual epidemic.
Subscribe to Journal
Get full journal access for 1 year
only $52.25 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
The official website for International Diabetes Foundation––South-East Asia. https://www.idf.org/our-network/regions-members/south-east-asia/members/94-india.html. Accessed 28 Feb 2019.
The atlas of heart disease and stroke. World Health Organization. https://www.who.int/cardiovascular_diseases/resources/atlas/en/.
Noncommunicable diseases country profiles 2018. World Health Organization. https://www.who.int/nmh/publications/ncd-profiles-2018/en/.
Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Angelantonioa ED, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32:1–8.
Sahay BK. API-ICP guidelines on diabetes 2007. J Assoc Physicians India. 2007;55:1–50.
Hypertension in Diabetic Study (HDS) . Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11:309–17.
Williams G. Hypertension in diabetes. In: Pickup J, Williams G, (eds). Textbook of diabetes. London: Blackwell Scientific Publications; 1991. p. 719–32.
Parving HH, Andersen AR, Smidt UM, Oxenboll B, Edsberg B, Christiansen JS. Diabetic nephropathy and arterial hypertension. Diabetologia. 1983;24:10–12.
Joshi SR, Saboo B, Vadivale M, Dani SI, Mithal A, Kaul U, et al. Prevalence of diagnosed and undiagnosed diabetes and hypertension in India—results from the Screening India’s Twin Epidemic (SITE) study. Diabetes Technol Ther. 2012;14:8–15. 14 (1)
Gupta R, Gaur K, Ram CVS. Emerging trends in hypertension epidemiology in India. J Hum Hypertens. 2018. https://doi.org/10.1038/s41371-018-0117-3.
Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585–96.
Gupta R, Al-Odat NA, Gupta VP. Hypertension epidemiology in India: meta-analysis of fifty-year prevalence rates and blood pressure trends. J Hum Hypertens. 1996;10:465–72.
Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18:73–78.
Thankappan KR, Sivasankaran S, Sarma PS, Mini G, Khader SA, Padmanabhan P, et al. Prevalence-correlates-awareness-treatment and control of hypertension in Kumarakom, Kerala: baseline results of a community-based intervention program. Indian Heart J. 2006;58:28–33.
Gupta R. Meta-analysis of prevalence of hypertension in India. Indian Heart J. 1997;49:450.
Das SK, Sanyal K, Basu A. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Int J Med Sci. 2005;2:70–78.
Singh PS, Singh PK, Zafar KS, Sharma H, Yadav SK, Gautam RK, et al. Prevalence of hypertension in rural population of Central India. Int J Res Med Sci. 2017;5:1451–5.
Gupta R, Gupta VP. Hypertension epidemiology in India: lessons from Jaipur Heart Watch. Curr Sci. 2009;97:349–55.
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;389:37–55.
Shanthirani CS, Pradeepa R, Deepa R, Premlatha G, Saroja R, Mohan V. Prevalence and risk factors of hypertension in a selected South Indian population. The Chennai Urban Population Study. J Assoc Physicians India. 2003;51:20–27.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.
Taing KY, Farkouh ME, Moineddin R, Tu JV, Jha P. Age and sex-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in India: a cross-sectional study. BMC Cardiovasc Disord. 2016;16:247.
Page RM, Stones E, Taylor O, Braudt K. Awareness and perceptions of type 2 diabetes risk factors, preventability, and complications among college students in Visakhapatnam, India. Int Q Community Health Educ. 2016;37:27–32.
Long AN, Dagogo-Jack S. The comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens. 2011;13:244–51.
Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.
Yamazaki D, Hitomi H, Nishiyama A. Hypertension with diabetes mellitus complications. Hypertens Res. 2018;41:147–56.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.
Sowers JR. Treatment of hypertension in patients with diabetes. Arch Intern Med. 2004;164:1850–7.
El-Atat F, McFarlane SI, Sowers JR. Diabetes, hypertension, and cardiovascular derangements: pathophysiology and management. Curr Hypertens Rep. 2004;6:215–23.
Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37:1053–9.
Govindarajan G, Sowers JR, Stump CS. Hypertension and diabetes mellitus. Eur Cardiovasc Dis. 2006;2:1–7.
Bakris G, Williams M, Dworkin L, Elliott W, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. J Kidney Dis. 2000;36:646.
Sowers JR, Haffner S. Treatment of cardiovascular and renal risk factors in the diabetic hypertensive. Hypertension. 2002;40:781–8.
Viswanathan V, Tilak P, Kumpatla S. Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: a 12 years observational study. Indian J Med Res. 2012;136:46–53.
Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82:307–15.
Registrar General of India. Causes of deaths in India, 2001–2003. New Delhi, India: Office of the Registrar General; 2009.
Registrar General of India. Sample Registration System Report. New Delhi, India: Office of the Registrar General. 2011 www.censusindia.gov.in/2011-common/sample_registration_system.html. Accessed 27 Jan 2016.
Institute for HealthMetrics and Evaluation (IHME) Global burden of disease (GBD) database. Seattle, WA: IHME, University of Washington; 20145. P. http://www.healthdata.org/gbd/data. Accessed 17 Jul 2015.
Rodgers A, Lawes C, MacMahon S. Reducing the global burden of blood pressure related cardiovascular disease. J Hypertens. 2000;18(Suppl 1):S3–S6.
Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321:412–9.
Tharkar S, Devarajan A, Kumpatla S, Viswanathan V. The socioeconomics of diabetes from a developing country: a population based cost of illness study. Diabetes Res Clin Pract. 2010;89:334–40.
Bhaskaran VP, Rau NR, Satyashankar, Acharya RR, Metgud CS, Koshy T. A study of the direct cost incurred by type 2 diabetes mellitus patients for their treatment at a large tertiary-care hospital in Karnataka, India. J Acad Hosp Adm. 2003;15:7–12.
Satyavani K, Kothandan H, Jayaraman M, Viswanathan V. Direct costs associated with chronic kidney disease among type 2 diabetic patients in India. Indian J Nephrol. 2014;24:141–7.
Khanna U. The economics of dialysis in India. Indian J Nephrol. 2009;19:1–4.
Adler AJ, Prabhakaran D, Bovet P, Kazi DS, Mancia G, Mungat-Singh V, et al. Reducing cardiovascular mortality through prevention and management of raised blood pressure. Glob Heart. 2015;10:111–22.
Angell S, De Cock KM, Frieden TR. A public health approach to global management of hypertension. Lancet. 2015;385:825–7.
Gupta R, Khedar RS, Panwar RB. Strategies for better hypertension control in India and other lower middle income countries. J Assoc Physicians India. 2016;64:58–64.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Viswanathan, V., Smina, T.P. Blood pressure control in diabetes—the Indian perspective. J Hum Hypertens 33, 588–593 (2019). https://doi.org/10.1038/s41371-019-0212-0
Journal of Human Hypertension (2019)