Authors: Riteeka Kumari Bhimani , Areeba Pervaiz , Raja Subhash Sagar , Salih Abdella Yusuf

Abstract

Background: Coronary artery disease (CAD) and essential hypertension (HTN) frequently coexist in late life and remain dominant drivers of cardiovascular mortality in the United States. We evaluated national trends and demographic disparities in CAD‑related mortality among older adults (≥65 years) with essential HTN from 1999–2020.

Methods: We queried the Centers for Disease Control and Prevention (CDC) Wide‑ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death (MCD) files. Deaths listing essential HTN (ICD‑10 I10) and ischemic heart disease/CAD (ICD‑10 I20–I25) as underlying or contributing causes were included. We calculated annual age‑adjusted mortality rates (AAMRs) per 100,000 using the 2000 U.S. standard population and estimated annual percent change (APC) and average annual percent change (AAPC) with Joinpoint regression (Version 5.1.0). Analyses were stratified by sex, race/ethnicity, U.S. Census region, urbanization, place of death, and state.

Results: We identified 1,878,811 deaths in older adults with coexisting essential HTN and CAD from 1999–2020. The overall AAMR rose sharply between 1999 and 2001 (APC, 67.81%; 95% CI, 13.99 to 123.72) and then declined modestly from 2001 to 2020 (APC, –1.22%; 95% CI, –2.50 to –0.20); overall AAPC was 3.89% (95% CI, 1.16 to 6.60). Men had consistently higher AAMRs than women across all years (period means, 244.9 vs 172.3 per 100,000). Non‑Hispanic (NH) Black older adults experienced the highest mean AAMR (271.1), followed by NH White (200.0), Hispanic (181.6), American Indian/Alaska Native (195.8), and Asian (149.2) populations. Regional rates were highest in the Midwest and South during the early 2000s, with declines thereafter; non‑metropolitan counties exhibited persistently higher AAMRs than metropolitan counties. Home and hospice deaths increased substantially over time, with a marked surge in 2020. State‑level AAMRs ranged from 104.7 (Utah) to 310.9 (Oklahoma).

Conclusions: Among U.S. older adults with essential HTN and CAD, mortality surged around the turn of the millennium and then declined slowly through 2020, with substantial and persistent disparities by sex, race/ethnicity, geography, and urbanization. These findings underscore the need for renewed, equity‑focused strategies to improve blood pressure control, secondary prevention of CAD, and access to high‑quality cardiovascular care particularly for NH Black and rural populations.

Keywords: Coronary Artery Disease, Mortality, Essential Hypertension, United States, CDC WONDER