Abstract 4142878: Temporal and Regional Trends of Mortality Related to Heart Failure in Hypertensive Older Adults in the United States from 1999-2020

Background: Hypertension is a leading cause of cardiovascular diseases (CVD) and is responsible for one-fourth of all cases of heart failure (HF). It affects approximately 75 million adults, or one in three US adults. Studies demonstrate an association between chronic hypertension and heart failure. Chronic hypertension causes pathological changes in the heart, increasing the risk of HF by twofold in men and by threefold in women. Treatment of high blood pressure prevents and reverses myocardial changes in patients at risk of HF. Objective: Our objective is to identify the mortality patterns related to HF due to hypertension in older adults in the United States, stratified by age, sex, region, and area, and to investigate any changes over time. Methods: We used the data from the CDC WONDER database to determine the crude death rates (CR) and age-adjusted mortality rates (AAMRs) per 100,000 individuals. Our study targeted individuals aged 65 and older. We examined the change in AAMR through annual percent change (APC) and the average annual percentage change (AAPC) using the Joinpoint regression. Results: From 1999 to 2020, HF caused 259,079 deaths in the hypertensive patient population in the US, demonstrating an increasing trend (AAPC = 5.5107). Females (28.57) had higher AAMRs than males (25.56). Non-Hispanic (NH) Black or African Americans had the highest AAMRs (43.99), while NH Asian or Pacific Islanders had the lowest (19.42). AAMRs also varied by region (West: 34.57, South: 27.74, Midwest: 26.78, Northeast: 21.44). Massachusetts and Tennessee had the highest percentage change in AAMRs, while the states with the lowest were New Hampshire and Colorado. Most deaths occurred at a hospice/nursing facility (57.9%). Non-metropolitan areas (30.69) had the highest AAMRs. Conclusions: We report concerning trends of heart failure in the hypertensive population in the US, with the highest mortality rates in females, NH Black/African Americans, and in the Western region. Future research should focus on targeted therapy for the vulnerable population and defining an optimal blood pressure target for HF patients, as the evidence is inconsistent and scarce on this topic.