Hypertension-Related CV Deaths Surging Across the US

Hypertension-related CV disease deaths are increasing across all age groups and all regional locations in America, according to a recent study. The most concerning uptick is being seen in the rural South.

“Our results provide additional insight into the prior observation that the overall rate of decline of cardiovascular disease mortality has slowed and heart failure-related cardiovascular disease deaths are now rising,” Lakshmi Nambiar, MD (University of Vermont Larner College of Medicine, Burlington, VT), told TCTMD in an email.

Just months ago, a JAMA Cardiology study drew attention to a troubling “Silver Tsunami,” in which gains in cardiovascular mortality in the United States have been leveling off due to a high population burden of diabetes and obesity in older individuals. Another study found that cardiovascular disease deaths related to heart failure were disproportionately more common in younger black men and women.

The new data from Nambiar and colleagues show that age-adjusted death rates per 100,000 attributed to hypertension-related CV disease increased from 18.3 in 2007 to 23.0 in 2017 (P < 0.001 for trend). During that same period, hypertension-related CV deaths surged by 72% in rural areas of the US and by 20% in urban populations (P < 0.001 for time trend), with increases in each region.

Over time, age-adjusted death rates increased across all age groups, with the highest proportion at every time point being in those ages 65- to 74-years old. Deaths in men due to hypertension-related CVD were consistently greater in men than women, but increased in both sexes over period of study.

This analysis of numbers from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research was originally accepted for presentation at the American College of Cardiology 2020 Scientific Session, and it was published online March 19, 2020, ahead of print in the Journal of the American College of Cardiology.

Adherence to New Hypertension Guidelines Crucial

To TCTMD, Nambiar said factors that likely account for such dramatic increases in hypertension-related deaths over the time period studied are multiple, and being fueled by obesity and diabetes in a rapidly aging population. As for rural populations, she noted that these “have unique challenges, including disparities in healthcare access/delivery and the social determinants of health.”

In the rural South, the risk of death from hypertension-related CV was 2.5-fold higher than in all other regions (P < 0.001). The absolute mortality rate for the rural south per 100,000 was 38.3 compared with 25.7 for the urban South, with both men and women affected in equal proportions.

According to the study authors, population-wide adherence to the most recent comprehensive hypertension guidelines, which encourage a treatment goal of lower than 130/80 mm Hg across all patient groups, needs to be a priority.

“Our study reinforces the importance of the [2017 US] hypertension guidelines in order to provide clinicians a more comprehensive approach to diagnosing and treating high blood pressure,” Nambiar said. “The rural South should be a target for public health measures.”