Hypertension Trends Show Increased Mortality Rate Over Last Decade

By Dave Quaile, /alert Contributor
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A research letter recently published in Hypertension, has shown an increase in total hypertension-related CVD deaths and overall AAMR for hypertension-related CVD between 2000 and 2018, despite targeted public health efforts. 

According to the letter from Sadiya S. Khan, MD, from the Feinberg School of Medicine at Northwestern University, US death rates have increased and marked race-sex disparities persist, despite the fact that hypertension is infrequently listed as an under- lying cause of death and is more often linked to CV death. 

“The 21st century has seen meaningful improvements in some aspects of cardiovascular health…but this progress appears to have been offset by coincident increases in the number of individuals with obesity or diabetes mellitus, which may be adversely contributing to hypertension-related CVD mortality rates,” Khan and colleagues wrote. 

Using data on morality from the Centers for Disease Control and Prevention, Khan and colleagues set out to comprehensively quantify trends in the burden of hypertension-related CVD deaths and inform public health strategies pertaining to hypertension.

The study included patients aged ≥25 years with any mention of hypertension and underlying cause of death listed as CVD between 2000 and 2018. 

The researchers also stratified deaths related to hypertension and CVD by leading CVD subtypes including ischemic heart disease as underlying cause of death, HF as underlying cause of death or any mention and cerebrovascular disease as underlying cause of death. 

Race- and sex-specific analyses were performed for black and white participants, however, due to concern for misclassification, the researchers did not stratify by ethnicity.

Using the 2000 US standard population, Khan and colleagues calculated age-adjusted mortality rates per 100000 population for all hypertension-related CVD deaths and for each CVD subtype.

Trend inflections in AAMR trends for hypertension-related CVD deaths in the overall population were identified using Joinpoint software.

All specified subgroups underwent a full analysis period to calculate average annual percentage change for linear AAMR trends between standardized inflection points (95%CI).

According to the study, the AAMR rate ratios of black and white patients were compared using the method from Boyle and Parkin and the statistical significance was indicated as being 2-sided by the researchers (P<.05.)

The results of the study show that total hypertension-related CVD deaths increased from 171,259 to 270,839 and overall AAMR for hypertension-related CVD increased by +0.5%/year (95% CI, +0.1 to +0.8), on average between 2000 and 2018. 

The researchers were able to identify a triphasic trend pattern with 2 inflection points; the overall AAMR increased between 2000 and 2003, decreased between 2003 and 2012, and increased again between 2012 and 2018. 

There was a 1.5%/year decline in the AAMR for hypertension- related ischemic heart disease deaths in CVD subtypes, a 1.8%/year increase in HF deaths and a stable number of cerebrovascular disease between 2000 and 2018.

In the earlier time periods, 2000 to 2012, The AAMR of hypertension-related CVD deaths increased for white men (90.1–100.8) and decreased for White women (79.2–75.7), Black men (220.1–197.0), and Black women (184.1–137.5) between 2000 and 2012, according to the study results. 

More recent periods, however, show that AAMR accelerated for white men (100.8–117.2), reversed for White women (75.7–81.5) and Black men (197.0–206.6), and decelerated for Black women (137.5–132.7). The researchers found similar for other CVD subtypes.

The rate ratio of hypertension-related CVD AAMR in black compared with white men was 2.44 (2.38–2.51) in 2000 and 1.76 (1.73–1.80) in 2018. The researchers observed a similar rate ratio of hypertension-related CVD AAMR in black and white women in both 2000 and 2018, respectively (2.32 [2.28–2.38] and 1.63 [1.60–1.66).

According to the researchers, the lack of individual level data on the control of hypertension in death certificates makes it impossible to differentiate between individuals with controlled vs uncontrolled hypertension.

“Nonetheless, our results show a consistent worsening of national mortality rates for all hypertension-related CVD and race-sex subgroups be- tween 2012 and 2018 and unacceptable persistent racial disparities in hypertension-related CVD mortality rates,” the researchers wrote. “Resources aimed at preventing and managing hypertension are urgently needed to reduce preventable deaths and reduce disparities.”

Disclosure: The researchers report no relevant financial disclosures.


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