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. 2025 May;27(5):e70064.
doi: 10.1111/jch.70064.

Trends and Disparities in Heart Failure Mortality Among Hypertensive Older Adults in the United States: A 22-Year Retrospective Study

Ahmed Raza  1 , Manal Kaleem  2 , Muhammad Aliyan Ahmed Shaikh  3 , Fatima Mansoor  4 , Muhammad Ansab  1 , Mustafa Turkmani  5   6 , Ubaid Khan  7
Affiliations

Trends and Disparities in Heart Failure Mortality Among Hypertensive Older Adults in the United States: A 22-Year Retrospective Study

Ahmed Raza et al. J Clin Hypertens (Greenwich). 2025 May.

Abstract

Hypertension (HTN) is a significant risk factor for heart failure (HF), and both significantly contribute to cardiovascular mortality. This study aims to examine trends and disparities in HF-related mortality among hypertensive older adults (≥65 years) in the United States from 1999 to 2020. Centers for Disease Control and Prevention-Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database data were analyzed, focusing on HTN as the underlying cause and HF as the contributing cause of death. Age-adjusted mortality rates (AAMRs) and crude rates were stratified by gender, race/ethnicity, age groups, urban-rural status, and geographic regions. The Joinpoint regression program was used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). A total of 259 079 HF-related deaths occurred among hypertensive older adults, with an overall AAMR increase from 11.27 in 1999 to 41.05 in 2020, indicating a clear upward trend (AAPC: 5.51%). Females had higher AAMRs (28.57) than males (25.56); however, males showed a steeper rise in mortality (AAPC: 6.15% vs. 5.23%). Non-Hispanic Blacks had the highest AAMR (43.99), while NH Whites exhibited the most significant increase (AAPC: 5.92%). Mortality rates were highest in the West (AAMR: 34.57) and lowest in the Northeast (21.44). Non-metropolitan areas had a higher AAMR than metropolitan areas (30.69 vs. 26.52). These findings emphasize the necessity for targeted interventions to diminish disparities and tackle increasing mortality rates in vulnerable populations, especially among women, NH Blacks, individuals in the West, and those living in non-metropolitan areas.

Keywords: demographic variations; heart failure; hypertension; mortality; mortality trends.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trends in the overall age‐adjusted mortality rates (AAMRs) related to heart failure in hypertensive older adults in the United States, 1999–2020.
FIGURE 2
FIGURE 2
Trends in sex‐stratified age‐adjusted mortality rates (AAMRs) related to heart failure in hypertensive older adults in the United States, 1999–2020.
FIGURE 3
FIGURE 3
Race and ethnicity‐stratified trends in age‐adjusted mortality rates (AAMRs) related to heart failure in hypertensive older adults in the United States, 1999–2020.
FIGURE 4
FIGURE 4
Trends in age‐adjusted mortality rates (AAMRs) related to heart failure in hypertensive older adults stratified by census regions in the United States, 1999–2020.
FIGURE 5
FIGURE 5
Trends in age‐adjusted mortality rates (AAMRs) related to heart failure in hypertensive older adults in the United States, mapped for each State of the United States, 1999–2020.
See this image and copyright information in PMC

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