AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Temporal Trends and Persistent Disparities in Mortality Associated with Hypertensive Diseases and Dementia Among United States Older Adults Aged ≥65 Years, 1999-2024
By wajahat K, Rehman G, Khan S et al.
Background and Aims: Hypertension (HTN) is considered a leading modifiable risk factor for dementia, yet trends in co-occuring HTN and dementia-related mortality remain incompletely characterized, particularly in the post-COVID-19 era. Prior analyses were limited to data through 2020. Research Question: We aimed to evaluate the 25-year trends and disparities in mortality associated with co-occurring hypertension and dementia among adults aged ≥65 years in the United States from 1999 to 2024. Methods: We used the CDC WONDER database to identify deaths among adults aged ≥ 65 years from 1999-2024 with co-listed ICD-10 codes for HTN (110-115) and dementia (F01, F03) as the multiple cause of death. Age-adjusted mortality rates (AAMR) per 100,000 population were then calculated. The Joinpoint regression Program was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) with 95% confidence intervals. Data were stratified by age group, race, region, sex, and urbanization level. Urbanization trends (metro vs non-metro) were analysed for 1999-2020; data after 2020 were not included as there was a concern over the reliability of the classification and completeness of urbanization codes during the COVID-19 pandemic. Result: A total of 1,171,151 deaths were identified among adults aged ≥65 years between 1999-2024 with a significant increase in overall AAMR (13.6 to 141.2).Following an initial steep rise from 1999 to 2001, both sexes demonstrated a sustained significant increase from 2001 to 2024. Females: APC 3.30 (95% CI 2.73–3.87, p<0.000001); males: APC 4.03 (95% CI 3.41–4.66, p<0.000001). Females accounted for more deaths than males (781,227 vs. 389,924). Non-Hispanic Blacks exhibited highest AAMR (215.1) rising significantly followed by Non-Hispanic Whites AAMR (149.13).Crude mortality rates increased across all age groups, with the 85+ age group showing the highest rate of increase from 1999 to 2024 (72.1 to 720.93 per 100,000; AAPC 7.77%, 95% CI (2.95-12.83).The South had the highest AAMR (178.37 per 100,000 in 2024; AAPC 8.07%) and was the only region with persistently rising rates post 2021, while the West had the lowest AAPC (6.66%). Other regions showed stabilization of AAMR post-pandemic period. All urbanization categories showed significant increases from 2001 to 2020.Non-Core (Non-metropolitan) areas had the steepest rise from 2001–2012 (APC: 6.26; 95% CI 5.58–6.94, p<0.000001; AAPC: 10.20, 95% CI 8.52–11.90, p<0.000001). Conclusions: HTN and dementia-associated mortality has increased significantly over 25 years, with disparities by sex, region, and urbanization. Despite post-pandemic period stabilization, rates remain far above pre-pandemic levels. Targeted HTN control strategies are needed, particularly for women, the Southern region, and rural communities to mitigate this growing burden.