Trends in Hypertension Related Cardiovascular Mortality in The United States, 2000-2018

Abstract

Background Despite targeted public health efforts, rates of hypertension (HTN) remain persistently high, and HTN control low with significant race-sex disparities. HTN infrequently causes death directly, but more commonly causes death through cardiovascular diseases (CVD), such as ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease. To comprehensively estimate the burden of HTN and inform prevention strategies, we determined trends in HTN-related CVD deaths overall and stratified by CVD subtypes in the United States. Methods Age-adjusted mortality rates (AAMR) were calculated based on death certificates of US residents ≥25 years (y) with any mention of HTN and CVD listed as the underlying cause of death between 2000-2018 (CDC WONDER). Joinpoint software identified inflection points in AAMR for HTN-related CVD. Trends in AAMR (average annual percentage change [AAPC, 95% CI]) of HTN-related CVD deaths as well as stratified by CVD subtype: IHD, HF, and cerebrovascular disease were calculated. All analyses were performed in all decedents and stratified by race-sex subgroups. AAMR rate-ratios (95% CI) of HTN-related CVD deaths in black compared with white men and women were calculated for 2018. Results Between 2000-2018, the AAMR of HTN-related CVD deaths increased by +0.5%/y (0.1, 0.8). A triphasic pattern in overall HTN-related CVD AAMR was identified (FIGURE): between 2000-2003, AAMR increased (+2.2%/y [0.4, 4.0]), between 2003-2012 AAMR decreased (-0.9%/y [-1.3, -0.5]), and between 2012-2018 AAMR increased again (+1.7%/y [1.1, 2.3]). Trends differed by CVD-subtype. The AAMR for HTN-related- IHD deaths declined -1.5 % /y (-1.8, -1.1), HF deaths increased 1.8%/y (1.4, 2.3), and cerebrovascular deaths remained stable -0.1%/year (-0.4, 0.2) between 2000-2018. For all CVD-subtypes AAMR increased in the most recent period (2012-2018) with significant disparities by race-sex. In 2018, AAMR of HTN-related CVD was 1.76 (1.73, 1.80) and 1.63 (1.60, 1.66) times higher in black compared with white men and women, respectively. Conclusions Since 2000, the AAMR for HTN-related CVD deaths has increased, particularly for HTN-related HF deaths. Trends consistently worsened between 2012-2018, with persistent racial disparities. Resources aimed at preventing and managing HTN are urgently needed to equitably reduce preventable CVD deaths. Despite targeted public health efforts, rates of hypertension (HTN) remain persistently high, and HTN control low with significant race-sex disparities. HTN infrequently causes death directly, but more commonly causes death through cardiovascular diseases (CVD), such as ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease. To comprehensively estimate the burden of HTN and inform prevention strategies, we determined trends in HTN-related CVD deaths overall and stratified by CVD subtypes in the United States. Age-adjusted mortality rates (AAMR) were calculated based on death certificates of US residents ≥25 years (y) with any mention of HTN and CVD listed as the underlying cause of death between 2000-2018 (CDC WONDER). Joinpoint software identified inflection points in AAMR for HTN-related CVD. Trends in AAMR (average annual percentage change [AAPC, 95% CI]) of HTN-related CVD deaths as well as stratified by CVD subtype: IHD, HF, and cerebrovascular disease were calculated. All analyses were performed in all decedents and stratified by race-sex subgroups. AAMR rate-ratios (95% CI) of HTN-related CVD deaths in black compared with white men and women were calculated for 2018. Between 2000-2018, the AAMR of HTN-related CVD deaths increased by +0.5%/y (0.1, 0.8). A triphasic pattern in overall HTN-related CVD AAMR was identified (FIGURE): between 2000-2003, AAMR increased (+2.2%/y [0.4, 4.0]), between 2003-2012 AAMR decreased (-0.9%/y [-1.3, -0.5]), and between 2012-2018 AAMR increased again (+1.7%/y [1.1, 2.3]). Trends differed by CVD-subtype. The AAMR for HTN-related- IHD deaths declined -1.5 % /y (-1.8, -1.1), HF deaths increased 1.8%/y (1.4, 2.3), and cerebrovascular deaths remained stable -0.1%/year (-0.4, 0.2) between 2000-2018. For all CVD-subtypes AAMR increased in the most recent period (2012-2018) with significant disparities by race-sex. In 2018, AAMR of HTN-related CVD was 1.76 (1.73, 1.80) and 1.63 (1.60, 1.66) times higher in black compared with white men and women, respectively. Since 2000, the AAMR for HTN-related CVD deaths has increased, particularly for HTN-related HF deaths. Trends consistently worsened between 2012-2018, with persistent racial disparities. Resources aimed at preventing and managing HTN are urgently needed to equitably reduce preventable CVD deaths.