Hypertension-related heart failure mortality among older adults in the United States: a nationwide analysis of demographic and regional trends

Although hypertension (HTN) is a major risk factor for heart failure (HF), limited national data exist on trends in mortality where HF is the underlying cause of death and HTN is a contributing factor among older adults aged ≥65 years. The aim of the study is to evaluate temporal, demographic, and regional trends in HTN-related HF mortality among older US adults from 1999 to 2020. We used CDC WONDER (Centers for Disease Control and Prevention WideRanging Online Data for Epidemiologic Research) mortality data to identify deaths with HF as the underlying cause and HTN as a contributing cause in individuals aged ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated by year, sex, race/ethnicity, region, and urban rural status. Join point regression was used to determine changes in trends over time. Between 1999 and 2020, 378,851 HTNrelated HF deaths occurred, most in nursing homes/longterm care facilities (34.7%), at home (31.2%), or in medical facilities (24.6%). The AAMR rose from 31.8 in 1999 to 38.3 in 2005 (APC 3.2; 95% CI, 2.2-4.7), declined to 34.0 in 2009 (APC –2.6; 95% CI, –4.6 to –0.7), remained stable through 2014, and then increased sharply to 66.1 in 2020 (APC 10.9; 95% CI, 9.9-12.6). Women had higher overall mortality than men (41.7 vs. 37.5). NH Black adults had the highest rates (64.1), followed by NH White (38.9), NH American Indian/Alaska Native (38.3), Hispanic/Latino (34.3), and NH Asian/Pacific Islander (26.2). Mississippi had the highest state-level rate (109.6), while Hawaii had the lowest (20.2). Regionally, the West (48.5) exceeded the Northeast (29.8). Non-metropolitan areas had higher mortality than metropolitan areas (44.9 vs. 39.5). We concluded that HTN-related HF mortality in older adults has risen markedly since 2014, with the greatest burden among women, NH Black adults, Western states, and rural populations. These findings underscore the need for improved HTN control and HF care in highrisk groups.