Dramatic Rise in Hypertension-Related Deaths in the United States

March 20, 2020

There has been a dramatic rise in hypertension-related deaths in the United States between 2007 and 2017, a new study shows.

The authors, led by Lakshmi Nambiar, MD, Larner College of Medicine, University of Vermont, Burlington, analyzed data from the Centers for Disease Control and Prevention, which collates information from every death certificate in the country, amounting to more than 10 million deaths.  

They found that age-adjusted hypertension-related deaths had increased from 18.3 per 100,000 in 2007 to 23.0 per 100,000 in 2017 (P < .001 for decade-long temporal trend).

Nambiar reported results of the study at an American College of Cardiology 2020/World Congress of Cardiology press conference on March 19. It was also published online on the same day in the Journal of the American College of Cardiology.

She noted that death rates due to cardiovascular disease have been falling over the past 20 years largely attributable to statins to treat high cholesterol and stents to treat coronary artery disease. But since 2011, the rate of decline in cardiovascular deaths has slowed. One contributing factor is an increase in heart failure-related deaths but there hasn't been any data in recent years on hypertension-related deaths.

"Our data show an increase in hypertension-related deaths in all age groups, in all regions of the United States, and in both sexes. These findings are alarming and warrant further investigation, as well as preventative efforts," Nambiar said. "This is a public health emergency that has not been fully recognized," she added.

"We were surprised to see how dramatically these deaths were increasing, and we think this is related to the rise in diabetes, obesity, and the aging of the population. We need targeted public health measures to address some of those factors," Nambiar told Medscape Medical News.

"We are winning the battle against coronary artery disease with statins and stents but we are not winning the battle against hypertension," she added.

Worst Figures in Rural South 

Results showed that hypertension-related deaths increased in both rural and urban regions, but the increase was much steeper in rural areas — a 72% increase over the decade compared with a 20% increase in urban areas.

The highest death risk was identified in the rural South, which demonstrated an age-adjusted 2.5-fold higher death rate compared with other regions (P < .001).

The urban South also demonstrated increasing hypertension-related cardiovascular death rates over time: age-adjusted death rates in the urban South increased by 27% compared with all other urban regions (P < .001).

But the absolute mortality rates and slope of the curves demonstrate the highest risk in patients in the rural South, the researchers report. Age-adjusted hypertension-related death rates increased in the rural South from 23.9 deaths per 100,000 in 2007 to 39.5 deaths per 100,000 in 2017.

Nambiar said the trends in the rural South could be related to social factors and lack of access to healthcare in the area, which has been exacerbated by failure to adopt Medicaid expansion in many of the states in this region.

"When it comes to the management of hypertension you need to be seen regularly by a primary care doctor to get the best treatment and regular assessments," she stressed.   

Chair of the ACC press conference at which the data were presented, Martha Gulati, MD, University of Arizona School of Medicine, Phoenix, said: "In this day and time, there is less smoking, which should translate into lower rates of hypertension, but these trends reported here are very different from what we would expect and are probably associated with the rise in other risk factors such as diabetes and obesity, especially in the rural South."

Nambiar praised the new ACC/AHA hypertension guidelines that recommend a lower diagnostic threshold, "so more people now fit the criteria for raised blood pressure and need treatment."

"It is important for all primary care physicians and cardiologists to recognize the new threshold and treat people accordingly," she said. "High blood pressure is the leading cause of cardiovascular disease. If we can control it better, we may be able to control some of this increased mortality we are seeing."

American College of Cardiology 2020/World Congress of Cardiology. Abstract 20-A-14942-ACC.  

J Am Coll Cardiol. Published online March 19, 2020. Abstract

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