AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Hypertensive Cardiorenal Mortality Co-Occurring With Heart Failure and End-Stage Renal Disease: A 25-Year National Trends Analysis
By Srivastava K, Zubair A, Arham M et al.
Introduction: Hypertension is the leading modifiable risk factor for cardiorenal spectrum, with progression to concurrent heart failure (HF) and end-stage renal disease (ESRD) representing a high-risk phenotype. We used a national database to evaluate temporal trends in hypertensive heart and renal disease mortality among adults in the U.S. presenting with co-occurring HF and ESRD. Methods: A retrospective population-based analysis was performed using CDC WONDER (1999-2024). Deaths among adults aged ≥45 years listing hypertensive heart and renal disease with both HF and ESRD (I13.2) as the underlying cause of death were included. Age-adjusted mortality rates (AAMRs) per 1,000,000 were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual (APC) and average annual percent changes (AAPC). Results: From 1999-2024, 90,570 deaths were identified (mean AAMR: 26.7). Mortality declined until 2010, followed by a significant increase thereafter (AAPC: +5.1; 95% CI: 3.6-6.7; p < 0.001). Increasing trends were observed in both sexes, with slightly higher AAMR in males (28.7 vs 25.3) and steeper post-2014 increases in both groups. The highest burden was observed in adults aged ≥85 years (48,379 deaths). Noncore (nonmetropolitan) areas demonstrated the highest mortality (AAMR: 27.6). All racial groups showed a post-2014 upward inflection, most pronounced among Black or African American individuals (AAMR: 50.1). Regionally, the highest mortality was observed in the South (AAMR: 29.7) and West (AAMR: 29.3). State-level AAMRs ranged from 9.5 (Connecticut) to 307.2 (Oklahoma). Conclusion: The disproportionately higher mortality among older adults, Black individuals, rural populations, and residents of the South highlights persistent inequities in outcomes. The rising mortality trends identify high-risk populations where targeted interventions may yield meaningful improvements in the mortality.