AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Rising National Mortality Trends Involving Hypertensive Heart and Renal Disease and Diabetes Mellitus in the United States, 1999-2024
By Ahsan S, Laique M, Arif A et al.
Introduction: Hypertensive heart and renal disease (HHRD) and diabetes mellitus (DM) frequently coexist and contribute to substantial cardiovascular and renal morbidity and mortality. This coexistence reflects a high-risk cardiometabolic phenotype characterized by accelerated target-organ damage and adverse clinical outcomes. Despite the growing burden of hypertension, diabetes, and chronic kidney disease in the United States, national mortality trends involving coexisting HHRD and DM remain poorly characterized. Therefore, this study examined mortality trends and disparities involving both HHRD and DM using CDC WONDER data from 1999-2024. Hypothesis: We hypothesized that mortality involving coexisting HHRD and DM increased from 1999 to 2024 and varied according to sex, race, geographic region, and urbanization status. Methods: We conducted a retrospective analysis of mortality data from the CDC WONDER Multiple Cause of Death database from 1999-2024. Deaths involving both hypertensive heart and renal disease (ICD-10 code I13) and diabetes mellitus (ICD-10 codes E10-E14) were identified when both conditions were listed among the multiple causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by year, sex, race/ethnicity, geographic region, and urbanization status. Joinpoint regression analysis was performed to estimate average annual percentage changes (AAPCs) with 95% confidence intervals (CIs). Analyses of urbanization status were limited to 1999-2020 because post-2020 urbanization data were unavailable. Results: Deaths involving both HHRD and DM totaled 65,934 between 1999 and 2024. The overall AAMR increased from 0.5 to 1.8, corresponding to an AAPC of 6.3% (95% CI, 4.06-8.62). Mortality increased more rapidly among males, with AAMR rising from 0.4 to 2.3 (AAPC 8.10%), compared with an increase from 0.5 to 1.5 among females (AAPC 4.89%). Regionally, the South exhibited the highest mortality burden, with AAMR increasing from 0.6 to 2.5, while the Midwest experienced the greatest relative increase (AAPC 7.61%; 95% CI, 6.24-9.00). Among racial and ethnic groups, non-Hispanic Black individuals had the highest mortality burden, with AAMR increasing from 1.7 to 3.3, whereas non-Hispanic White individuals experienced the greatest relative increase (AAPC 8.06%; 95% CI, 7.02-9.99). Metropolitan areas demonstrated a slightly greater increase in mortality than non-metropolitan areas from 1999-2020. Conclusion: Mortality involving both HHRD and DM increased markedly over the past 25 years, with substantial disparities by sex, race/ethnicity, and geographic region. The disproportionate burden observed among non-Hispanic Black individuals and Southern residents underscores the need for equitable cardiometabolic prevention strategies and improved risk-factor control in vulnerable populations