Global Prevalence, Risk Factors, and Clinical Consequences of Coexisting Prediabetes and Prehypertension: A Systematic Review and Meta-Analysis

Introduction: Prediabetes and prehypertension are highly prevalent intermediate metabolic states that often coexist, potentially synergistically increasing cardiometabolic risk. Understanding their combined global burden, associated risk factors, and clinical outcomes is essential for developing effective preventive strategies. Objective: This systematic review and meta-analysis aimed to quantify the global prevalence, identify associated demographic and metabolic risk factors, and assess clinical outcomes linked to the coexistence of prediabetes and prehypertension. Methods: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Scopus databases from January 2000 to July 2025. Eligible studies included observational and interventional research reporting primary data on coexisting prediabetes and prehypertension. Data synthesis employed random-effects meta-analysis. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool. Results: Fifteen studies encompassing 149,585 participants were included. Meta-analysis of ten studies revealed a significantly increased hazard rate for coexistence (HR=1.62; 95% CI: 1.39–1.89; p<0.05), with moderate heterogeneity (I²=50.2%). Key independent risk factors included increased age (OR per decade: 1.41; 95% CI: 1.24–1.61), male sex (OR: 1.36; 95% CI: 1.12–1.65), and higher BMI (OR per 1 kg/m²: 1.18; 95% CI: 1.14–1.23). Longitudinal data demonstrated markedly elevated risks for incident diabetes (HR: 2.84; 95% CI: 2.13–3.78) and hypertension (HR: 2.21; 95% CI: 1.71–2.85). Pooled intervention data (n=2 RCTs) showed modest but significant improvements: mean systolic BP reduction of -4.1 mmHg (95% CI: -6.7, -1.5) and HbA1c reduction of -0.18% (95% CI: -0.25, -0.11). Conclusion: The coexistence of prediabetes and prehypertension is common and substantially elevates the risk for overt cardiometabolic disease. Integrated risk stratification and targeted multifactorial prevention strategies are essential to address this significant public health challenge.