DOI: https://doi.org/10.14710/jekk.v11i3.32189

Association between Physical Inactivity and Hypertension among Adults with Diagnosed Diabetes Mellitus in Indonesia: A National Cross-Sectional Analysis

*Sely Anggraini  -  Master's Degree Program in Epidemiology, Faculty of Public Health, University of Indonesia, Indonesia, Indonesia
Feranita Utama orcid  -  Department of Public Health, Faculty of Public Health, Sriwijaya University, Indonesia, Indonesia
Received: 15 May 2026; Revised: 30 Aug 2026; Accepted: 31 Aug 2026; Available online: 31 Aug 2026; Published: 31 Aug 2026.

Citation Format:
Abstract

Background: Diabetes mellitus and hypertension frequently coexist and increase the risk of cardiovascular complications. Although physical inactivity is a modifiable risk factor, national evidence on its association with hypertension among adults with diabetes mellitus in Indonesia remains limited. Aims: To examine the association between physical inactivity and hypertension among adults with diagnosed diabetes mellitus in Indonesia.

Methods: This cross-sectional study analyzed Riskesdas 2018 data from 9,807 adults with diagnosed diabetes mellitus. Hypertension was defined as blood pressure ≥140/90 mmHg, while physical inactivity was defined as <3,000 MET-minutes/week based on GPAQ. Survey-weighted logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: Overall, 38.2% of adults with diabetes mellitus had hypertension, and 58.0% had insufficient physical activity. After adjustment for age, sex, smoking status, duration of diabetes, anti-diabetic medication use, obesity, and central obesity, participants with insufficient physical activity had higher odds of hypertension than those with sufficient physical activity (aOR = 1.20; 95% CI: 1.06–1.35; p = 0.004).

Conclusion: Physical inactivity was significantly associated with higher odds of hypertension among adults with diabetes mellitus in Indonesia. These findings support the importance of promoting physical activity as part of comprehensive diabetes management.

Fulltext View|Download Email colleagues
Keywords: Physical inactivity ; Hypertension ; Diabetes mellitus ; Cross sectional studies

Article Metrics:

Article Info
Section: Articles
Language : EN
  1. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation; 2017
  2. Perkumpulan Endokrinologi Indonesia. Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia. Jakarta: PB PERKENI; 2021
  3. Kementerian Kesehatan Republik Indonesia. Laporan Survei Kesehatan Indonesia (SKI). Jakarta: Kementerian Kesehatan Republik Indonesia; 2023
  4. Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. August 2018;18(1). doi: 10.1186/s12889-018-5806-x
  5. Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension. Journal of Clinical Hypertension. January 2013;15(1):14–33. doi: 10.1111/jch.12049
  6. American Diabetes Association. Standards of medical care in diabetes—2017 abridged for primary care providers. Clinical Diabetes. 2017;35(1):5–26. doi: 10.2337/cd16-0067
  7. Puspa Sari G, Samekto M, Sakundarno Adi M. Risk factors affecting hypertension in type II diabetic patients (studies at primary healthcare centers in Pati District). Jurnal Litbang. 2017;13(1):47–59
  8. Basrowi RW, Rahayu EM, Khoe LC, Wasito E, Sundjaya T. The road to healthy ageing: what has Indonesia achieved so far? Nutrients. October 2021;13(10). doi: 10.3390/nu13103441
  9. Kementerian Kesehatan Republik Indonesia. Laporan Riset Kesehatan Dasar 2018 Nasional. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018
  10. Ranasinghe PD, Pokhrel S, Anokye NK. Economics of physical activity in low- income and middle-income countries: a systematic review. BMJ Open. January 2021;11(1). doi: 10.1136/bmjopen-2020-037784
  11. Schröders J, Wall S, Hakimi M, Dewi FST, Weinehall L, Nichter M, et al. How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PLoS ONE. June 2017;12(6). doi: 10.1371/journal.pone.0179186
  12. Ihyauddin Z, Marthias T, Anindya K, Ng N, Dewi FST, Hulse ESG, et al. The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample. BMC Health Services Research. December 2022;22(1). doi: 10.1186/s12913-022-08546-6
  13. Kenore Y, Abrha S, Yosef A, Gelgelu TB. Determinants of hypertension among patients with diabetes mellitus in public hospitals of Kembata Tambaro Zone, Southern Nations, Nationalities and Peoples' Region, Ethiopia, 2021: a case-control study. Journal of Multidisciplinary Healthcare. September 2022;15:2141–2152. doi: 10.2147/JMDH.S379293
  14. Kementerian Kesehatan Republik Indonesia. Comprehensive Type 2 Diabetes Management Training Module for Doctors in Primary Health Care Facilities. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023
  15. Gambardella J, Morelli MB, Wang X, Santulli G. Pathophysiological mechanisms underlying the beneficial effects of physical activity in hypertension. Journal of Clinical Hypertension. February 2020;22(2):291–295. doi: 10.1111/jch.1380
  16. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology. May 2018;34(5):575–584. doi: 10.1016/j.cjca.2017.12.005
  17. Liu X, Zhang D, Liu Y, Sun X, Han C, Wang B, et al. Dose-response association between physical activity and incident hypertension: a systematic review and meta-analysis of cohort studies. Hypertension. May 2017;69(5):813–820. doi: 10.1161/HYPERTENSIONAHA.116.08994
  18. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology. April 2012;2(2):1143–1211. doi: 10.1002/cphy.c110025
  19. Sakr HF, Sirasanagandla SR, Das S, Bima AI, Elsamanoudy AZ. Insulin resistance and hypertension: mechanisms involved and modifying factors for effective glucose control. Biomedicines. August 2023;11(8). doi: 10.3390/biomedicines11082271
  20. Muniyappa R, Sowers JR. Role of insulin resistance in endothelial dysfunction. Reviews in Endocrine and Metabolic Disorders. March 2013;14(1):5–12. doi: 10.1007/s11154-012-9229-1
  21. Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D, et al. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries: a scoping review. BMC Public Health. November 2019;19(1). doi: 10.1186/s12889-019-7842-6
  22. Monfared V, Hashemi M, Kiani F, Javid R, Yousefi M, Hasani M, et al. The effect of physical activity intervention on blood pressure in 18 low- and middle-income countries: a systematic review and meta-analysis of randomized controlled trials. Clinical Hypertension. December 2024;30(1). doi: 10.1186/s40885-024-00281-w
  23. Teh CH, Chan YY, Lim KH, Kee CC, Lim KK, Yeo PS, et al. Association of physical activity with blood pressure and blood glucose among Malaysian adults: a population-based study. BMC Public Health. December 2015;15(1). doi: 10.1186/s12889-015-2528-1
  24. Salameh AB, Hyassat D, Suhail A, Makahleh Z, Khader Y, El-Khateeb M, et al. The prevalence of hypertension and its progression among patients with type 2 diabetes in Jordan. Annals of Medicine and Surgery. January 2022;73. doi: 10.1016/j.amsu.2021.103162
  25. Chapman N, Ching SM, Konradi AO, Nuyt AM, Khan T, Twumasi-Ankrah B, et al. Arterial hypertension in women: state of the art and knowledge gaps. Hypertension. June 2023;80(6):1140–1149. doi: 10.1161/HYPERTENSIONAHA.122.20448
  26. Ramanathan S. Correlation of duration, hypertension, and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital. Integrative Molecular Medicine. 2017;4(1). doi: 10.15761/IMM.1000272
  27. Kemche B, Saha Foudjo BU, Fokou E. Risk factors of hypertension among diabetic patients from Yaoundé Central Hospital and Etoug-Ebe Baptist Health Centre, Cameroon. Journal of Diabetes Research. 2020;2020. doi: 10.1155/2020/1853516
  28. Negussie YM, Abebe AT. Hypertension and associated factors among patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. Scientific Reports. December 2025;15(1). doi: 10.1038/s41598-025-97909-0
  29. Jia G, Sowers JR. Hypertension in diabetes: an update of basic mechanisms and clinical disease. Hypertension. November 2021;78(5):1197–1205. doi: 10.1161/HYPERTENSIONAHA.121.17981
  30. Rahma G, Gusrianti G. Hubungan obesitas sentral dengan hipertensi pada penduduk usia 25–65 tahun. JIK-Jurnal Ilmu Kesehatan. October 2019;3(2):118. doi: 10.33757/jik.v3i2.239
  31. Hasandokht T, Farajzadegan Z, Dana Siadat Z, Paknahad Z, Rajati F. Lifestyle interventions for hypertension treatment among Iranian women in primary health-care settings: results of a randomized controlled trial. Journal of Research in Medical Sciences. 2015;20:54
  32. West-Pollak A, Then EP, Podesta C, Hedelt A, Perry ML, Izarnotegui WV, et al. Impact of a novel community-based lifestyle intervention program on type 2 diabetes and cardiovascular risk in a resource-poor setting in the Dominican Republic. International Health. 2014;6(2):118–124. doi: 10.1093/inthealth/iht039
  33. Kobashi Y, Haque SE, Sakisaka K, Amir I, Kaneko M, Mutahara M, et al. Community-based intervention for managing hypertension and diabetes in rural Bangladesh. Tropical Medicine and Health. December 2024;52(1). doi: 10.1186/s41182-023-00574-0
  34. Ozoemena EL, Iweama CN, Agbaje OS, Umoke PCI, Ene OC, Ofili PC, et al. Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: a quasi-experimental study. Archives of Public Health. May 2019;77(1). doi: 10.1186/s13690-019-0349-x
  35. Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Puolijoki H, et al. Family history of diabetes and effectiveness of lifestyle counselling on the cardio-metabolic risk profile in individuals at high risk of type 2 diabetes: 1-year follow-up of the FIN-D2D project. Diabetic Medicine. February 2012;29(2):207–211. doi: 10.1111/j.1464-5491.2011.03388.x
  36. Rintamäki R, Rautio N, Peltonen M, Jokelainen J, Keinänen-Kiukaanniemi S, Oksa H, et al. Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care. Primary Care Diabetes. June 2021;15(3):444–450. doi: 10.1016/j.pcd.2021.03.002
  37. Rahajeng E. Penguatan Posbindu PTM dalam menurunkan prevalensi faktor risiko penyakit tidak menular utama. Jakarta: Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia; 2020

Last update:

No citation recorded.

Last update:

No citation recorded.