When Two Risks Collide: Diabetes–Hypertension Clustering and Cardiovascular Outcomes in Saudi Adults Aged 25–50 Years — A Systematic Review

Sheikh Ahmed¹, Aidrous Ali², Ahmed Almubarak³, Mohammed Elhaj⁴

Abstract

Doi : https://doi.org/10.5281/zenodo.19153531 

Diabetes mellitus and hypertension are two of the most common and significant cardiometabolic problems worldwide and often occur together in the same patient; they also markedly increase the cardiovascular risk. In Saudi Arabia, rapid epidemiological transition, urbanisation, and lifestyle changes have had a role in the increase in the burden of both conditions, including among younger adults. While these individual conditions have been reported to be independent risk factors for cardiovascular morbidity and mortality, the extent of risk for their co-occurrence among the Saudi adult (25 to 50 years of age) population has not been fully synthesised. This is a systematic review of the relationship between diabetes alone, hypertension alone, and combined exposure to diabetes and hypertension with fatal and non-fatal CVDs in this population. Identification of studies published from 2010 to 2025 from major databases using predefined eligibility criteria was carried out. Eligible studies had to be able to diagnose those who had neither condition, those who had diabetes, those who had hypertension, and those who had both. Effect estimates were synthesised in a narrative way in order to evaluate the hypothesis that clustering has an additive or multiplicative excess cardiovascular risk. The review also discusses commonly-adjusted covariates, and the statistical adjustment is how the reported association is affected by statistical analysis. These findings aim to elucidate the cardiovascular implications suggested by cardiometabolic clustering in a younger Saudi population and may help us in the risk stratification and prevention strategies.