Increasing Contribution of Hypertensive Diseases to Cardiovascular Mortality, United States (2018-2024)

ABSTRACT Background Hypertensive disease mortality has risen in the United States (U.S.) despite historical declines in several major cardiovascular disease (CVD) causes. Whether hypertension’s proportional contribution to total CVD mortality has shifted overall and across demographic subgroups has not recently been comprehensively characterized. Methods We analyzed national mortality data from the CDC WONDER, 2018 through 2024. Hypertensive disease deaths were defined by ICD-10 codes I10-I15; CVD deaths by I00-I99. The primary outcome was the percentage of annual hypertension disease mortality share of CVD mortality, calculated from age-adjusted mortality rates and age-specific, crude mortality rates. Temporal trends were assessed with Joinpoint regression (annual percent change (APC)), stratified by sex, age, and race/ethnicity. Results The hypertensive disease mortality as a share of CVD mortality rose from 11.1% in 2018 to 15.0% in 2024 (APC 5.10%, 95% CI 3.22-7.37; p <0.001). Statistically significant positive within-group APCs were observed among both sexes, all individuals 35 years and older, and all racial/ethnic groups. The numerically largest APCs were observed among non-Hispanic (NH) White (APC 6.02%) and NH American Indian or Alaska Native individuals (APC 4.80%). NH Black or African American individuals had the highest observed proportional burden of hypertensive disease share, reaching 18.8% of CVD deaths in 2024. Conclusions Hypertensive disease mortality accounts for a growing share of U.S. CVD mortality overall, with significant increases across both sexes, all racial/ethnic groups, and adults aged ≥35 years. Reversing these trends will require greater focus on the management of hypertension to improve associated mortality and subsequently overall CVD mortality.