What does this research mean for the field?

Aortic dissection mortality in perimenopausal women (45-64 years) exceeds that of aortic aneurysm, while older cohorts (65-84 years) show the opposite trend. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

February 8, 2026

Temporal trends of mortality in hypertensive females with aortic aneurysm versus aortic dissection: a retrospective analysis of perimenopausal and older cohorts (1999 - 2023)

Key Result

From 2018-2021, mortality in hypertensive women surged sharply for aortic aneurysm (APC +9.56%) and dissection (APC +9.94%), with non-Hispanic Blacks having highest mortality rates.

Key Points

Examine mortality disparities from hypertension-related aortic aneurysm and dissection in perimenopausal and older women.
Analyzed death certificate data from CDC-WONDER (1999-2023)
Focused on hypertensive women aged 45 and older
Calculated crude and age-adjusted mortality rates
Used Joinpoint to estimate annual percent change in mortality trends
21,096,65 deaths due to HTN-related AA or AD were reported
Mortality for HTN with AA increased from 1999-2004, declined to 2012, and sharply rose from 2018-2021
AD mortality trends mirrored AA with comparable increases during the same periods
Racial disparities highlighted highest mortality in non-Hispanic Black individuals
Older cohorts demonstrated higher AA mortality compared to AD, contrasting with younger perimenopausal women.

Structured PICO

Population

Females aged 45 years or older in the United States with hypertension and either aortic aneurysm or aortic dissection (n=21,096,65 deaths).

Outcome

Mortality (crude mortality rates and age-adjusted mortality rates per 100,000 population)hard clinical

Mortality from hypertension-related aortic aneurysm and dissection in US women aged 45 and older has increased from 1999 to 2023, with distinct age-dependent patterns and pronounced racial disparities.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Perimenopausal women with hypertension (HTN) are at heightened risk for aortic pathologies, including aortic aneurysm (AA) and aortic dissection (AD), due to the convergence of hormonal-induced vascular remodeling and chronic hemodynamic stress. This physiological interplay potentially creates a unique cardiovascular risk signature with increased mortality compared to premenopausal women with similar conditions. Purpose We examine disparities in HTN related AA versus AD mortality among perimenopausal and older United States (U.S.) women. We hypothesize significant mortality differences exist based on age, race, and geographic region, addressing an important gap in contemporary epidemiological data. Methods This retrospective study analyzed death certificate data from the CDC-WONDER database from 1999 to 2023. The study focused on HTN (ICD-10: I10–I15) related AD (ICD-10: I71.1) versus AA (ICD-10: I71.3–I71.9) as the underlying cause of mortality among females aged 45 years or older. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Joinpoint was used to estimate annual percent change (APC) in mortality trends. Results A total of 21,096,65 deaths were reported with coexisting HTN and either AA or AD. Mortality trends for both conditions showed significant fluctuations over the study period. For HTN with AA, mortality increased from 1999 to 2004 (APC: +2.09%), declined from 2004 to 2012 (APC: -1.10%), and sharply rose from 2018 to 2021 (APC: +9.56%). Similarly, HTN with AD mortality increased from 1999 to 2003 (APC: +3.67%), declined from 2003 to 2012 (APC: -0.44%), and peaked sharply from 2018 to 2021 (APC: +9.94%). Long-term trends showed an average annual percent change (AAPC) of +2.01% for AA and +2.55% for AD, with both conditions experiencing notable mortality increases, particularly between 2018 and 2021. Racial disparities were evident, with non-Hispanic Black individuals having the highest AAMRs for both HTN and AA or AD. Age-specific trends revealed a crossover pattern: AD mortality exceeded AA mortality in younger perimenopausal women (45–64 years), while AA mortality surpassed AD in older cohorts (65–84 years), with rates reaching 9.8 vs. 2.7 per 100,000 in the 80–84 age group. AD mortality was highest in Mississippi and lowest in Minnesota, whereas AA mortality was highest in Kentucky and lowest in California. Conclusion The study reveals a distinct age-dependent mortality pattern, with AD exceeding AA in younger women (45–64 years) and AA surpassing AD in older cohorts (65–84 years). Racial disparities were pronounced, with NH Black individuals having the highest AD mortality. Sharp mortality increases from 2018–2021 underscore urgent public health needs.Figure 1. Figure 2.

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