No age group, region, or gender was immune to the recent rise in hypertension-related deaths in the U.S., researchers found.
Hypertension-related mortality, adjusted for age, increased from 18.3 per 100,000 deaths in 2007 to 23.0 per 100,000 in 2017 (P<0.001), with similar patterns across various subgroups:
Increases for both men and women over time, though men tended to have higher risk in general
Increases by 72% in rural and 20% in urban populations (P<0.001 for both)
Increases across all geographic regions
Mortality jumped fastest in the rural South, where there was a 2.5-fold higher hypertension-related death rate compared with other regions (P<0.001), according to Lakshmi Nambiar, MD, of the University of Vermont Larner College of Medicine in Burlington.
Nambiar presented her study during a press briefing ahead of this year's virtual American College of Cardiology meeting (the regular meeting cancelled on account of COVID-19). The paper was also published online in the Journal of the American College of Cardiology.
Researchers had previously noted a slowdown in the decline in cardiovascular disease (CVD) mortality in the country, attributable in part to heart failure-related deaths being on the rise since 2012. Now there appears to have been a similar inflection point in hypertension-related CVD deaths around that time, according to Nambiar.
"The fact that the rates are rising is no surprise to anyone. The geographic differences are not totally surprising either. What's surprising was the amount of difference between the South and the rest of the country," commented Eileen Handberg, PhD, ARNP, of University of Florida Health in Gainesville, who was not involved with the study.
"What people had predicted about obesity and lifestyle is coming to fruition," Handberg said in an interview. "I think people sort of anticipated that with the increase of obesity and the increase in hypertension, that we were going to see a change in mortality rates. This is what people have been screaming about."
There were positive signals in Nambiar's study, however, she said, as sedentary lifestyle, obesity, and hypertension are modifiable risk factors that present opportunities for improvement.
"It's clear we need some major interventions if we're going to change that trajectory," Handberg said. "This is an opportunity for the NIH and other funding agencies to look at how we can work on obesity and hypertension control and focus some of this effort into rural communities."
Nambiar and colleagues analyzed death certificates spanning the years 2007 to 2017 from the CDC WONDER database. They found records of 10.5 million deceased.
Deaths said to have CVD as the underlying cause and hypertension as a contributing cause were counted as hypertension-related deaths.
Biostatistician George Howard, DrPH, of the University of Alabama at Birmingham, advocated caution in interpreting the study because of the problems with relying on death certificate data. He also questioned what exactly it means for someone to have been listed as dying from hypertension.
Another limitation of the study was the lack of information on certain variables, such as medication adherence or social determinants of health, Nambiar added.
Race could have been a major confounder, especially when looking at urban-rural differences by census region, according to Howard.
"Basically, there are very few black rural African Americans if you are not living in the south. So, about 18% of the rural population in the south is African American, while it is only 1% to 2% in other regions. But blacks have a much higher prevalence of hypertension, and could be more likely to be coded as dying from hypertension," he told MedPage Today.
Last Updated March 19, 2020
Study authors reported no conflicts of interest.
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