Introduction: Intracerebral hemorrhage (IH) and cerebral infarction (CI) are leading causes of stroke mortality in older adults, with hypertension as a principal modifiable risk factor. Although stroke mortality has declined overall, long-term comparisons between these subtypes in hypertensive elderly populations remain insufficient. Methods: CDC WONDER mortality data (1999–2020) were analyzed for decedents aged ≥65 years with hypertension (I10) as the underlying cause of death and IH (I61) or CI (I63) as contributing causes. Age-adjusted mortality rates (AAMRs) per 100,000 were standardized to the 2000 U.S. population. Trends were assessed using Joinpoint regression, reporting annual percent change (APC) with 95% confidence intervals, stratified by sex, race/ethnicity, census region, and urbanization. Results: We identified 101,452 IH-related and 48,670 CI-related deaths. IH mortality declined steadily (AAMR 11.08; APC –2.10%, p<0.001) across all demographics. CI mortality followed a biphasic trajectory—decreasing from 1999–2013 (APC –6.13%, p<0.01) then rising sharply from 2013–2020 (APC 19.01%, p<0.001). IH rates were higher in men overall (11.25) but converged with women by 2020; CI rose more steeply in men post-2013. By race/ethnicity, IH declined in White (APC –2.28%) and Black groups (–2.04%), while CI increased among Hispanic (AAMR 9.04 in 2020) and Asian/Pacific Islander populations. Regionally, IH was highest in the West (10.92) and lowest in the Northeast (7.59) in 2020, whereas CI increases were consistent across regions, with the West and Northeast peaking at 10.94. Declines in IH occurred in both metropolitan (APC –2.28%) and rural (–1.49%) areas, but CI mortality rose in both after 2013 (19.65% vs 16.36%). IH deaths were mainly inpatient, while CI occurred more frequently at home or hospice, reflecting distinct clinical trajectories. Conclusion: IH mortality has declined among hypertensive older adults, reflecting advances in blood pressure control, imaging, and acute care. In contrast, the resurgence in CI mortality after 2013 signals systemic drivers, including rising vascular risk burden, inequities in advanced therapies, and treatment delays. These findings underscore the need for intensified risk factor control, equitable access to acute stroke interventions, and strategies tailored to vulnerable subgroups.
Patel et al. (Thu,) studied this question.