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

Abstract

Background: Cardiovascular disease is a leading cause of death in older adults who have both renal failure
and hypertensive disease. However, national trends describing mortality in this high-risk population remain
unclear.

Hypothesis: We hypothesized that cardiovascular mortality in older adults with renal failure and hypertensive
disease experienced significant changes from 1999 to 2020, with variations by sex, race, region, and urbanization status.

Methods: We used public-use mortality data from the Centers for Disease Control and Prevention for decedents ≥65 years with renal failure and hypertensive disease listed as contributing conditions and cardiovascular disease as the underlying cause of death. Annual percentage changes (APCs) in age-adjusted mortality rates were estimated using joinpoint regression. Statistical significance was set at P < 0.05.

Results: From 1999 to 2012, the overall mortality rate rose modestly (APC ~+2.1; P = 0.12), followed by a sharp decline from 2012 to 2015 (APC ~−47; P < 0.01). A subsequent increase from 2015 to 2020 (APC ~+13; P = 0.09) was not statistically significant. Analyses by sex showed similar patterns, with males and females both exhibiting substantial downturns between 2012 and 2015. Race and ethnicity subgroups likewise demonstrated steep drops (APC ~−43% to −53%) during 2012-2015, followed by partial rebounds. Regionally, the West had a small but significant rise from 1999 to 2012 (APC ~+3.6; P = 0.01) before a pronounced decline (APC ~−48; P = 0.001). Both metropolitan and non-metropolitan areas reflected the overall trend, with mild increases until 2012, then marked reductions, and modest upticks thereafter.

Conclusions: In older adults with renal failure and hypertensive disease, cardiovascular mortality underwent
a modest increase through 2012, a dramatic dip from 2012 to 2015, and a partial rebound afterward. These
patterns underscore the importance of ongoing surveillance and targeted prevention strategies to reduce
cardiovascular burden in this susceptible population.

Keywords: Cardiovascular Disease, Mortality, Renal Failure, Hypertension