Abstract 4368122: The Gender Gap in Hypertension Control: A NHANES–CDC WONDER Analysis of 12,400 Preventable Cardiovascular Deaths in U.S Women (2017–2022)

Background: Hypertension-related cardiovascular disease (CVD) mortality in women has increased by 2.2% annually in recent years, while national hypertension control rates among women remain stagnant at 23.1%. Despite this trend, no prior study has quantified preventable CVD deaths among U.S. women by race/ethnicity and age using linked national datasets. Research Question: What is the extent of preventable cardiovascular mortality due to uncontrolled hypertension among U.S. women, and how do disparities in hypertension control rates by race/ethnicity, age, and geographic location contribute to this burden between 2017 and 2022? Methods: We analyzed approximately 60,000 female CVD deaths with hypertension listed as a contributing cause (ICD-10 I10–I15) from CDC WONDER between 2017 and 2022. Hypertension prevalence and control rates (<130/80 mmHg) were assessed using data from approximately 3,000 women in NHANES 2017–2020. Geographic disparities in hypertension control were evaluated using CDC PLACES data. Population-attributable fractions were calculated to estimate the contribution of uncontrolled hypertension to CVD mortality. Adjusted odds ratios for mortality risk were derived using multivariable logistic regression models that accounted for age, race/ethnicity, and comorbidities. Regional mortality patterns were mapped against control rate disparities. Results: Among U.S. women, hypertension prevalence was 44.8%, with 23.1% controlled. Age-adjusted CVD mortality was 31.2 per 100,000. Uncontrolled hypertension raised CVD mortality risk (OR 2.4; 95% CI: 2.0–2.9). Black women had 56.7% prevalence, 19.8% control, a 45.3 per 100,000 mortality rate (OR 2.7; 95% CI: 2.3–3.2). Rural women showed 47.2% prevalence, 21.3% control, and 35.6 per 100,000 mortality (OR 2.6; 95% CI: 2.1–3.1), lower than urban control rates (25.7%, p<0.01). Women aged 65+ had 68.3% prevalence, 18.9% control, and 110.5 per 100,000 mortality (OR 3.0; 95% CI: 2.6–3.5). Uncontrolled hypertension caused 12,400 annual CVD deaths, highlighting disparities in older, Black, and rural women. Conclusions: Uncontrolled hypertension is responsible for a substantial proportion of preventable cardiovascular deaths among U.S. women. The burden is especially pronounced among Black women, those living in rural areas, and older adults. Interventions aimed at closing the gender gap in hypertension control are urgently needed to address this preventable mortality crisis.