Abstract FR482: Trends and Disparities in Coronary Artery Disease Mortality Among U.S. Adults with Essential Hypertension (1999–2020)

Background: Coronary artery disease (CAD) significantly contributes to mortality in hypertensive populations. This study examines national trends and disparities in CAD-related age-adjusted mortality among U.S. adults with essential hypertension from 1999–2020. Methods: Data from the CDC WONDER multiple-cause mortality database (1999–2020) were analyzed. Deaths involving both essential hypertension and CAD were identified. Annual age-adjusted mortality rates (AAMRs) per 100,000 were computed and stratified by sex, race/ethnicity, region, and urbanization. Joinpoint regression detected trends and calculated annual percent changes (APCs). Automated assistive writing tools supported manuscript preparation. Results: CAD mortality among hypertensive adults sharply increased from 1999–2001 (APC 67.8%, p<0.05), then consistently decreased through 2020 (APC -1.2%, p<0.05). Sex-stratified analyses revealed similar patterns, with females experiencing more pronounced declines post-2001 (female APC -2.1%, male APC -0.3%; both p<0.05). Racial/ethnic groups showed early spikes followed by declines, except for Hispanics who demonstrated a recent significant rise (2018–2020 APC +14.7%, p<0.05). American Indian/Alaska Native populations had the slowest decline (2005–2020 APC -2.0%, p<0.05). Regional mortality consistently declined across the Northeast, Midwest, South, and West (APCs -0.7% to -1.7%; p<0.05). Metropolitan areas had greater declines post-2001 (APC -1.4%, p<0.05) than nonmetropolitan areas (APC -0.1%, not significant), maintaining rural–urban disparities. Conclusions: After a brief increase in the early 2000s, CAD mortality among hypertensive adults has declined, though disparities persist. Recent increases among Hispanic populations and limited improvements in rural and American Indian/Alaska Native groups underscore the necessity for targeted interventions to achieve cardiovascular health equity.