Abstract 4359210: Temporal Trends and Differences in Hypertension-Related Atherosclerotic Cardiovascular Disease (ASCVD) Mortality in the United States, 2000–2021

Background: Hypertension is a major contributor to atherosclerotic cardiovascular disease (ASCVD), a leading cause of death in the United States. However, national trends in hypertension-related ASCVD mortality remain poorly defined. Aims: To assess trends and demographic differences in hypertension-related ASCVD mortality from 2000 to 2021. Methods: We analyzed CDC WONDER multiple-cause-of-death data (2000–2021) for adults aged ≥25 years. Deaths were included if ASCVD was the underlying cause (ICD-10: I20–I25, I63, I70, I71.1–I71.9, I72.1–I74, I77.8–I77.9) and hypertension (I10–I15) a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, and region. Results: Between 2000 and 2021, 2,160,197 hypertension-related ASCVD deaths occurred among adults in the U.S. Overall AAMRs declined from 45.4 in 2000 to 41.4 in 2009 (APC: –2.40 [–3.12 to –1.67]), plateaued through 2015 (APC: –0.18 [–0.55 to 0.19]), rose to 44.6 in 2019 (APC: 2.24 [1.82 to 2.66]), and increased to 52.4 by 2021 (APC: 8.79 [6.89 to 10.73]). Men consistently had higher AAMRs than women from 2000 (AAMR men: 52.1 vs women: 35.3) to 2021 (men: 70.6 vs women: 37.3). Among women, AAMRs declined from 38.2 in 2004 to 30.2 in 2015 (APC: –3.24 [–3.81 to –2.66]), then rose through 2021 (APC: 8.53 [6.27 to 10.83]). Among men, AAMRs declined from 54.9 in 2005 to 52.6 in 2009 (APC: –1.40), then increased through 2021 (APC: 8.40 [6.83 to 9.99]). Non-Hispanic Black adults had the highest AAMRs throughout the study period, reaching 76.1 in 2021, followed by Non-Hispanic White (52.1), Hispanic (34.9), and Asian adults (27.5). Although urban AAMRs were higher in 2000, rural rates surpassed them in 2004 and remained elevated, reaching 59.0 vs. 48.4 for urban in 2020. Regionally, the South had the highest AAMR in 2021 (58.4), and the Midwest had the steepest recent increase from 2019 to 2021 (AAMR: 42.7 to 49.8; APC: 11.54 [7.98 to 15.22]). Conclusion: Hypertension-related ASCVD mortality declined in the early 2000s but reversed in the mid-2010s, accelerating after 2019. The highest and fastest-growing rates were seen among men, Non-Hispanic Black adults, rural populations, and residents of the South and Midwest. These trends underscore the urgent need for targeted interventions and improved hypertension control to reduce the growing burden.