Under Pressure: A 22-Year National Analysis of Mortality From Aortic Dissection and Aneurysm With Hypertension in US Adults 25 to 85 Years of Age (1999–2020)

Aortic dissection and aneurysm are deadly complications of hypertension and remain important causes of cardiovascular mortality. Due to the rise in prevalence of hypertension in the United States, it is critically important that we analyze mortality trends for vascular emergencies. Using national data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research, we analyzed mortality from the age of 25 up through 85 years and older from the period between 1999 and 2020. Crude mortality rates, age-adjusted mortality rates, and yearly percent change and the corresponding 95% confidence intervals were estimated. From 113,728 reported deaths due to aortic dissection and aneurysm and hypertension during the study interval, mortality trends indicated a mortality rate initially decreasing from 2.42 in 2001 to 2.27 in 2015, and subsequently increasing to 2.67 in 2015–2020, representing a total rise from 1.64 in 1999 to a level of 2.67 in 2020. Mortality was higher among males than females throughout the period, at levels of 3.87 and 1.77 per 100,000 in 2020. Disparities by race and ethnicity also emerged, as non-Hispanic Black race showed the maximum mortality, followed by non-Hispanic Asian and non-Hispanic White, and much lower among Hispanics and in non-Hispanic American Indian. Geographic variations also became apparent, as evidenced by the West reporting the maximum mortality burden. These findings indicate that after reductions observed in the past, mortality from aortic dissection and aneurysm related to hypertension has increased in recent years, emphasizing the importance of targeted prevention interventions.