Temporal Trends and Disparities in Hypertension‐Related Cardiomyopathy Mortality in the United States, 1999–2023

BACKGROUND: Hypertension and cardiomyopathy are major contributors of cardiovascular morbidity in the United States. This study investigates long-term mortality trends and disparities in hypertension-related cardiomyopathy from 1999 to 2023 in the United States. METHODS: Mortality data from CDC WONDER (1999-2023) were evaluated for cardiomyopathy (ICD-10 I42, I42.2, and I42.9) as the primary cause of death and hypertension (ICD-10 I10, I15.0 and I15.9) as a contributing cause among individuals aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) were standardized to the United States 2000 population. Joinpoint regression estimated annual percent change (APC) with 95% confidence intervals. RESULTS: Between 1999 and 2023, 153 563 deaths were identified. AAMR increased from 1.26 per 100 000 in 1999 to 2.22 in 2023, driven by a significant early rise from 1999 to 2001 (APC: +30.33; p < 0.005). Males had higher mortality than females (2.98 vs. 1.61) with males declining significantly from 2001 to 2023 (APC: -0.64; p < 0.005). NH Black individuals had the highest AAMR (10.81), followed by NH White individuals (5.02). Mortality was higher in non-metropolitan than metropolitan areas (2.71 vs. 2.26), both declining significantly after 2001 (APC: -0.89; -1.69; p < 0.005). South had the highest burden (AAMR: 4.86), while the Midwest rose significantly after 2017 (APC: +4.11; p < 0.005). Adults aged ≥ 85 years had the highest mortality (CMR: 32.79) increasing significantly after 2015 (APC: +2.44 p < 0.005). CONCLUSION: Hypertension-related cardiomyopathy mortality rose sharply in 1999-2001 before declining through 2023, with persistent disparities by sex, race, geography, and age. Targeted hypertension control and equitable cardiovascular care remain needed to reduce this burden.