AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Rising Mortality Burden of Hypertensive Heart Disease and Cardiometabolic Comorbidities in Older U.S. Adults: A CDC WONDER Analysis, 1999-2024
By Eman S, Mahrukh M, Asad S et al.
Background: Hypertensive heart disease (HHD) is a significant contributor to cardiovascular morbidity and mortality among older adults, frequently being accompanied by cardiometabolic conditions that further worsen clinical outcomes. Despite the increasing burden of hypertension, diabetes, obesity, and metabolic disorders in the aging population, long term national mortality trends and demographic disparities associated with HHD remain insufficiently characterized. This study evaluated temporal mortality trends related to HHD and cardiometabolic comorbidities among United States (U.S) adults aged ≥65 years using CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) data from 1999-2024. Methods: Mortality data from adults aged ≥65 years with hypertensive heart disease (HHD; ICD-10: I11) and cardiometabolic comorbidities, including diabetes mellitus (E10-E14), obesity (E66), disorders of lipoprotein metabolism (E78), metabolic disorders (E88), and essential hypertension (I10), were analyzed using the CDC WONDER Multiple Cause of Death database from 1999-2024. Mortality rates were stratified by sex, age group, race, census, region, and urbanization status. Joinpoint regression analysis was performed to evaluate temporal mortality trends using annual percent change (APC) and 95% confidence intervals (CI). Results: HHD-related mortality with cardiometabolic comorbidities increased from 3,360 deaths in 1999 to 47,604 deaths in 2024, while the age-adjusted mortality rate rose from 9.76 to 83.71 per 100,000 population. Overall mortality increased significantly from 1999-2006 (APC, 16.7%; p<0.001), followed by a persistent upward trend through 2024 (APC, 6.0%; p=0.036). Mortality increased in both sexes, with women demonstrating accelerated growth after 2013 (APC, 6.9%; p=0.010). Adults aged 75-84 years showed continuously increasing trends, whereas adults aged ≥85 years experienced the steepest rise between 2003-2006 (APC, 64.5%; p=0.015). Significant increases were observed in the Midwest, Northeast, metropolitan populations, and racially in Black individuals. Conclusions: Mortality associated with HHD and cardiometabolic comorbidities has risen markedly among U.S. adults aged ≥65 years over the past 25 years, with persistent demographic and geographic disparities. These findings highlight the growing cardiovascular burden of combined hypertensive and metabolic disease in older adults. Further research is essential to better understand the sociodemographic and healthcare related factors contributing to these disparities and to support the development of targeted prevention, risk-factor optimization, and equitable cardiovascular care strategies.