Excess hypertension-related mortality among cancer patients in the United States: a SEER-based study

Abstract Cancer remains a leading cause of mortality globally, while hypertension is the primary contributor to cardiovascular disease and premature death. These conditions frequently coexist; hypertension may precede cancer due to shared risk factors or arise during or after cancer treatment, partly as a result of the hypertensive effects of antineoplastic therapies. As cancer survival rates improve, effective management of comorbid hypertension has become increasingly important. In this study we analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, which includes 17 registries and cover approximately 34.6% of the U.S. population, this study evaluated hypertension-related mortality among cancer patients diagnosed between 2000 and 2021. Causes of death were stratified by demographic, clinical, treatment, and cancer-specific characteristics. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated across survival intervals. Among 6,891,191 patients with malignant disease, 17,780 deaths (0.26%) were attributed to hypertension. Hypertension-related mortality was 24% higher than in the general population (SMR 1.24, 95% CI 1.22–1.26), with the greatest excess observed within the first year after diagnosis (SMR 2.04, 95% CI 1.97–2.11). Elevated risk was identified among patients younger than 40 years, racial minorities, unmarried individuals, those with regional or distant disease, and those who did not receive surgery, radiotherapy, or chemotherapy, particularly during the first year after diagnosis. No improvement in hypertension mortality was observed during 2010–2021, and females exhibited a slightly higher risk than males. SMRs did not decrease over time, and females exhibited a slightly higher risk than males. These findings support the consideration of early and sustained onco-hypertension management and coordinated care among oncologists, cardiologists, and primary care physicians. Further research examining patient-level risk factors, comorbidities, treatment strategies, and socioeconomic determinants is essential to improve survival outcomes among cancer survivors.