•  
  •  
 

Abstract

Hypertension is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and substantially increases the risk of both macrovascular and microvascular complications. Data on the determinants of hypertension status among T2DM patients in primary healthcare settings remain limited. This study aimed to analyze the determinants of hypertension status in T2DM patients at Puskesmas Menteng during 2024–2025. This was an analytic observational study employing a cross-sectional design. Study subjects comprised T2DM patients registered and undergoing examinations at Puskesmas Menteng over the 2024–2025 period. Data were extracted from electronic medical records, included age, sex, occupation, socioeconomic status, blood pressure, hypertension status, diabetes duration, body mass index (BMI), kidney function (estimated glomerular filtration rate; eGFR), total cholesterol, low-density lipoprotein cholesterol, triglycerides, and urinary albumin. Hypertension status was classified as hypertensive or non-hypertensive. Multivariable logistic regression analysis was performed, and the results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). A total of 462 patients with T2DM were analyzed, including 349 patients (75.5%) with hypertension and 113 patients without hypertension. In the multivariable analysis, obesity was significantly associated with increased odds of hypertension (aOR 2.36; 95% CI:1.17–4.78;p=0.017). Microalbuminuria (aOR 1.82;95%CI:1.11–3.00;p=0.019) and macroalbuminuria (aOR 3.47;95%CI:1.29–9.32;p=0.014) were also significantly associated with hypertension. HbA1c levels

Keywords: Type 2 diabetes mellitus, Hypertension,  Glycemic Control, Hemoglobin  A1c, Primary Health Care

References

  1. Perkumpulan Endokrinologi Indonesia. Buku Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2024. Jakarta: Perkumpulan Endokrinologi Indonesia; 2024.
  2. Chen S, Zhu Y, Jin S, Zhao D, Guo J, Chen L, et al. Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study. BMC Cardiovasc Disord. 2023 Oct; 23: 501. https://doi.org/10.1186/s12872-023-03478-3
  3. International Diabetes Federation. IDF diabetes atlas 10th ed. Brussels: International Diabetes Federation; 2021.
  4. Kementerian Kesehatan Republik Indonesia. Riset kesehatan dasar (Riskesdas) 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.
  5. Kementerian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana hipertensi dewasa. Jakarta: Kementerian Kesehatan Republik Indonesia; 2021.
  6. Sharma H, Agarwal N, Agarwal P, Agarwal M. Relationship between hypertension incidence and glycemic control in type 2 diabetes mellitus. Asian Journal of Medical Sciences. 2025 Dec; 17(1): 77–81. https://doi.org/10.71152/ajms.v17i1.4961
  7. Perkumpulan Endokrinologi Indonesia. Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2021. Jakarta: PB PERKENI; 2021.
  8. Yamazaki D, Hitomi H, Nishiyama A. Hypertension with diabetes mellitus complications. Hypertens Res. 2018 Jan; 41(3): 147–156. https://doi.org/10.1038/s41440-017-0008-y
  9. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes Metab Syndr Obes. 2013 Sep; 6: 327-338. https://doi.org/10.2147/DMSO.S51325
  10. World Health Organization. Hypertension fact sheet. Geneva: World Health Organization; 2023.
  11. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2023. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.
  12. The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. New Engl Jour of Medic. 2011 Mar; 364(9): 829–841. https://doi.org/10.1056/NEJMoa1008862
  13. Fox CS, Coady S, Sorlie PD. Trends in Cardiovascular Complication of Diabetes. JAMA Net. 2004 Nov; 292(20): 2495-2499. https:doi.org/10.1001/jama.292.20.2495
  14. DeFronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia. 2010 Jul; 53: 1270–1287. https://doi.org/10.1007/s00125-010-1684-1
  15. Hall JE. The kidney, hypertension, and obesity. Hypertens. 2003; 41(3): 625–633. https://doi.org/10.1161/01.HYP.0000052314.95497.78
  16. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001 Dec; 414(6865): 813–820. https://doi.org/10.1038/414813a
  17. Singh VP, Bali A, Singh N, Jaggi AS. Advanced glycation end products and diabetic complications. The Korean Journal of Physiology & Pharmacology. 2014 Feb; 18(1): 1-14. https://doi.org/10.4196/kjpp.2014.18.1.1
  18. American Diabetes Association Professional Practice Committee. Cardiovascular disease and risk management: standards of care in diabetes. Diabetes Care. 2024 Jan; 47(Suppl 1): S179–S218. https://doi.org/10.2337/dc24-S010
  19. Zhang H, Li G, Li F, Jiang J. Body mass index and the risk of hypertension-diabetes comorbidity in elderly population: a prospective cohort in China. Global Heart. 2025 Oct; 20(1): 97. https://doi.org/10.5334/gh.1487
  20. Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Jones DL, et al. Obesity‐related hypertension: pathogenesis, cardiovascular risk, and treatment. J Clin Hypertens. 2012 Dec; 15(1): 14–33. https://doi.org/10.1111/jch.12049
  21. Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity-induced hypertension. Circulat Resear. 2015 Mar; 116(6): 991–1006. https://doi.org/10.1161/CIRCRESAHA.116.305697
  22. Parvanova A, Reseghetti E, Abbate M, Ruggenenti P. Mechanisms and treatment of obesity-related hypertension-part 1: mechanisms. Clin Kidney J. 2023 Nov; 17(1): sfad282. https://doi.org/10.1093/ckj/sfad282
  23. Kim YG, Jeong JH, Han DK, Roh SY, Min K, Lee HS, et al. Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus. Cardiovasc Diabetol. 2023 Feb; 22(1): 36. https://doi.org/10.1186/s12933-023-01769-9
  24. Gugun AM, Suryanto, Nugroho MEF, Bari PB. HbA1c and blood pressure correlation in patients with uncontrolled type 2 diabetes mellitus. Internat J of Health and Pharmaceu. 2024; 3(11): 2425–2434. https://doi.org/10.55927/fjsr.v3i11.12269
  25. Struijs JN, Baan CA, Schellevis FG, Westert GP, Bos GAM. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006 Jul; 6(1): 84. https://doi.org/10.1186/1472-6963-6-84
  26. American Diabetes Association Professional Practice Committee. Obesity and weight management for the prevention and treatment of type 2 diabetes. Diabet Care. 2024 Jan; 47 (Supplement_1): S145–S157. https://doi.org/10.2337/dc24-S008
  27. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002 Jan; 359(9302): 248–252. https://doi.org/10.1016/S0140-6736(02)07451-2
  28. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr; 105(4S): S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
  29. Baasiako CA, Obeng KA, Arthur KNA, Musah L, Abaido B, Awuviri HW, et al. Association between albuminuria and retinal microvascular dysfunction in type 2 diabetes with and without hypertension. Diabetes Epidem and Manage. 2023 Sep; 11: 100139. https://doi.org/10.1016/j.deman.2023.100139
  30. Bae ES, Hur JY, Jang HS, Kim JS, Kang HS. Risk factors of microalbuminuria among patients with type 2 diabetes mellitus in Korea: a cross-sectional study based on 2019–2020 Korea national health and nutrition examination survey data. Int J Environ Res Public Health. 2023 Jan; 20(5): 4169. https://doi.org/10.3390/ijerph20054169
  31. American Diabetes Association Professional Practice Committee. Glycemic goals and hypoglycemia: standards of care in diabetes—2024. Diabet Care. 2024 Jan; 47(Suppl 1): S111–S125. https://doi.org/10.2337/dc24-S006
  32. American Diabetes Association Professional Practice Committee. Chronic kidney disease and risk management: standards of care in diabetes—2025. Diabet Care. 2025; 48(Suppl 1): S239-S251. https:doi.org/10.2337/dc25-S011
  33. Sterne JAC, Cox DR, Smith GD. Sifting the evidence-what’s wrong with significance tests? Another comment on the role of statistical methods. BMJ. 2001; 322(7280): 226–231. https://doi.org/10.1136/bmj.322.7280.226
  34. Nlandu Y, Lepira F, Makulo JR, Engole Y, Sumaili E, Wameso MN, et al. Reverse epidemiology of elevated blood pressure among chronic hemodialysis black patients with stroke: a historical cohort study. BMC Nephrol. 2017 Aug; 18(1): 277. https://doi.org/10.1186/s12882-017-0697-0
  35. Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, Greenland S, Kopple JD. Reverse epidemiology of hypertension and cardiovascular death in the hemodialysis population. Hypertension. 2005 Feb; 45(4): 811–817. https://doi.org/10.1161/01.HYP.0000154895.18269.67
  36. Sun Z. Aging, arterial stiffness, and hypertension. Hypertension. 2014 Nov; 65(2): 252–256. https://doi.org/10.1161/HYPERTENSIONAHA.114.03617
  37. Liu L, Mu J, Wang X, Gu Y, Zhou S, Ma X, et al. Risk factors for developing hypertension in patients with type 2 diabetes: a cross-sectional study. Medicine. 2025 Jun; 104(26): e43104. https://doi.org/10.1097/MD.0000000000043104
  38. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
  39. Olvera Astivia OL, Gadermann A, Guhn M. The relationship between statistical power and predictor distribution in multilevel logistic regression: a simulation-based approach. BMC Med Res Methodol. 2019 May; 19(1): 97. https://doi.org/10.1186/s12874-019-0742-8
  40. van Smeden M, de Groot JA, Moons KG, Collins GS, Altman DG, Eijkemans MJC, et al. No rationale for 1 variable per 10 events criterion for binary logistic regression analysis. BMC Med Res Methodol. 2016 Nov; 16(1): 163. https://doi.org/10.1186/s12874-016-0267-3
  41. Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart J. 2016 Jul; 37(25): 1944–1958. https://doi.org/10.1093/eurheartj/ehw152
  42. Steiner MJ, Skinner AC, Perrin EM. Fasting might not be necessary before lipid screening: a nationally representative cross-sectional study. Pediatrics. 2011 Sep; 128(3): 463–470. https://doi.org/10.1542/peds.2011-0844
  43. Grundy SM, Stone NJ, Bailey AL, Beam C, Bitcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019 Jun; 139(25): e1082-e1143. https://doi.org/10.1161/CIR.0000000000000625
  44. American Diabetes Association Professional Practice Committee. Cardiovascular disease and risk management: standards of care in diabetes—2024. Diabet Care. 2023 Dec; 47(Suppl 1): S179-S218. https://doi.org/10.2337/dc24-S010
  45. Taheri A, Khezri R, Dehghan A, Rezaeian M, Aune D, Rezaei F. Hypertension among persons with type 2 diabetes and its related demographic, socioeconomic and lifestyle factors in the Fasa cohort study. Sci Rep. 2024 Aug; 14(1): 18892. https://doi.org/10.1038/s41598-024-69062-7
  46. American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes—2024. Diabet Care. 2024  Jan; 47(Suppl 1): S1–S4. https://doi.org/10.2337/dc24-SINT
  47. Kurniawan F, Sigit FS, Trompet S, Yunir E, Tarigan TJE, Harbuwono DS, et al. Lifestyle and clinical risk factors in relation with the prevalence of diabetes in the Indonesian urban and rural populations: The 2018 Indonesian Basic Health Survey. Preventive Med Rep. 2024 Feb; 38: 102629. https://doi.org/10.1016/j.pmedr.2024.102629
  48. Bahardoust M, Shokohyar S, Maleki F, Shafiee A, Tehrani FM, Ghaffari A. Socioeconomic inequalities and type 2 diabetes comorbidities: a systematic review and meta‐analysis on observational studies. Endocrinol, Diabetes & Metabo. 2026 Jan; 9(1): e70160. https://doi.org/10.1002/edm2.70160
  49. Adnan ML, Pratama YY. Association between gender and occupation with hypercholesterolemia risk among hypertension population: a cross-sectional study. J Divers Med Res. 2025; 2(9): 428–439. https://doi.org/10.33005/jdiversemedres.v2i9.213
  50. Pasambo Y, Efendi F, Pradipta RO, Murti FAK, Syahri A, Alam S. Socioeconomic disparities among people with diabetes mellitus (DM) in Indonesia. Sage Open J. 2025 Oct; 15(4). https://doi.org/10.1177/21582440251385984
  51. Serdar CC, Cihan M, Yucel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochem Med. 2021 Feb; 31(1): 27–53. https://doi.org/10.11613/BM.2021.010502
  52. Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. Executive summary of the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease: known knowns and known unknowns. Kidney International. 2024 Apr; 105(4): 684–701. https://doi.org/10.1016/j.kint.2023.10.016
  53. Shin J, Chang AR, Grams ME, Coresh J, Ballew SH, Surapaneni A. Albuminuria testing in hypertension and diabetes: an individual-participant data meta-analysis in a global consortium. Hypertension. 2021 Aug; 78(4): 1042–1052. https://doi.org/10.1161/HYPERTENSIONAHA.121.17323

Bahasa Abstract

Hipertensi merupakan komorbid pada pasien diabetes melitus tipe 2 dan berperan dalam meningkatkan risiko komplikasi makrovaskular maupun mikrovaskular. Hal ini dapat mempercepat kerusakan organ target. Data mengenai determinan status hipertensi pada pasien DM tipe 2 di fasilitas pelayanan kesehatan primer masih terbatas, khususnya di Puskesmas Menteng. Penelitian bertujuan untuk menganalisis determinan status hipertensi pada pasien DM tipe 2 di Puskesmas Menteng tahun 2024–2025. Penelitian ini merupakan studi observasional analitik dengan desain potong lintang. Subjek penelitian adalah pasien DM tipe 2 yang terdaftar dan menjalani pemeriksaan rutin di Puskesmas Menteng periode 2024–2025. Data diperoleh dari rekam medis elektronik yang meliputi usia, jenis kelamin, pekerjaan, dan status ekonomi, dan karakteristik klinis meliputi tekanan darah, status hipertensi, lamanya menderita DM, IMT, fungsi ginjal (GFR), pemeriksaan laboratorium (kolesterol total, LDL, trigliserida, albumin urin). Status hipertensi diklasifikasikan menjadi hipertensi dan non-hipertensi. Analisis dilakukan menggunakan regresi logistik multivariat, dan hasil dilaporkan dalam adjusted odds ratio (aOR) serta 95% confidence interval (CI). Sebanyak 462 pasien DM tipe 2 dianalisis, terdiri atas 349 pasien (75,5%) hipertensi dan 113 pasien (24,5%) non-hipertensi. Pada analisis multivariat, obesitas berhubungan signifikan dengan peningkatan odds hipertensi (aOR 2,36; 95%CI: 1,17–4,78; p=0,017). Mikroalbuminuria (aOR 1,82; 95%CI: 1,11–3,00; p=0,019) dan makroalbuminuria (aOR 3,47; 95%CI: 1,29–9,32; p=0,014) juga berhubungan signifikan dengan hipertensi. Kadar HbA1c/dl berasosiasi positif dengan status hipertensi, sementara fungsi ginjal menunjukan asosiasi yang inkonsisten dengan status hipertensi.

Kata Kunci: Diabetes Melitus Tipe 2, Hipertensi, Kontrol glikemik, Hemoglobin A1c, Pelayanan Kesehatan Primer

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.