What is the clinical evidence from this study?

Study design: Observational. Population: Older adults (≥65 years) with essential hypertension and coronary artery disease (n=1878811). Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 population aged ≥65 years from essential hypertension and CAD (APC 67.81% increase from 1999-2001, then APC −1.22% decline from 2001-2020; overall AAPC 3.89%, 95% CI 95% CI 13.99-123.72 (1999-2001 increase), −2.50 to −0.20 (2001-2020 decline), 1.16-6.60 (AAPC)).

What question did this study set out to answer?

This analysis aims to evaluate trends and disparities in coronary artery disease-related mortality among older adults with essential hypertension in the U.S.

February 19, 2026Open Access

Coronary Artery Diseaserelated mortality among older adults with essential hypertension in the United States, 19992020: A retrospective CDC WONDER analysis

Key Result

Among US adults aged ≥65 with essential hypertension and CAD, age-adjusted mortality rates rose sharply by 67.81% from 1999 to 2001, then declined modestly by 1.22% annually through 2020, with overall average annual percent change of 3.89%.

Key Points

This analysis aims to evaluate trends and disparities in coronary artery disease-related mortality among older adults with essential hypertension in the U.S.
Used CDC WONDER Multiple Cause of Death data files from 1999-2020.
Included deaths with essential hypertension and ischemic heart disease as causes.
Calculated annual age-adjusted mortality rates (AAMRs).
Estimated annual percent change (APC) using Joinpoint regression, stratified by demographic factors.
Identified 1,878,811 deaths among older adults with coexisting hypertension and CAD.
AAMR surged from 1999 to 2001, then declined slightly until 2020.
Men had higher AAMRs than women; NH Black adults had the highest AAMR.
Geographical disparities noted, with higher rates in the Midwest and South; non-metropolitan areas had consistently higher rates.
Home and hospice deaths increased over time, especially in 2020.

Study Design

Type

Observational (n=1,878,811)

Multicenter

Yes

Structured PICO

Population

1,878,811 deaths in U.S. older adults (≥65 years) with coexisting essential hypertension (ICD-10 I10) and ischemic heart disease/CAD (ICD-10 I20-I25) listed as underlying or contributing causes of death from 1999-2020.

Outcome

Annual age-adjusted mortality rates (AAMRs) per 100,000 U.S. population aged ≥65 yearshard clinical

Among U.S. older adults with essential hypertension and CAD, mortality surged around 1999-2001 and then declined slowly through 2020, with persistent disparities by sex, race/ethnicity, and geography.

Main Result

Effect estimate: APC 67.81% increase from 1999-2001, then APC −1.22% decline from 2001-2020; overall AAPC 3.89% (95% CI 95% CI 13.99-123.72 (1999-2001 increase), −2.50 to −0.20 (2001-2020 decline), 1.16-6.60 (AAPC))

Absolute Event Rate: 244.88% vs 172.31%

Limitations

Use of death certificate data may lead to misclassification or under-reporting of hypertension and CAD.
ICD-10 codes capture presence but not severity, duration, treatment, or control of hypertension and CAD.
Lack of granular socioeconomic variables in CDC WONDER data.
Age adjustment uses Year-2000 standard which may alter absolute magnitudes relative to older reports.
Study period ends in 2020 and does not capture subsequent COVID-19 pandemic waves and recovery trends

Abstract

Background: Coronary artery disease (CAD) and essential hypertension (HTN) frequently coexist in late life and remain dominant drivers of cardiovascular mortality in the United States. We evaluated national trends and demographic disparities in CAD‑related mortality among older adults (65 years) with essential HTN from 19992020. Methods: We queried the Centers for Disease Control and Prevention (CDC) Wide‑ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death (MCD) files. Deaths listing essential HTN (ICD‑10 I10) and ischemic heart disease/CAD (ICD‑10 I20I25) as underlying or contributing causes were included. We calculated annual age‑adjusted mortality rates (AAMRs) per 100,000 using the 2000 U.S. standard population and estimated annual percent change (APC) and average annual percent change (AAPC) with Joinpoint regression (Version 5.1.0). Analyses were stratified by sex, race/ethnicity, U.S. Census region, urbanization, place of death, and state. Results: We identified 1,878,811 deaths in older adults with coexisting essential HTN and CAD from 19992020. The overall AAMR rose sharply between 1999 and 2001 (APC, 67.81%; 95% CI, 13.99 to 123.72) and then declined modestly from 2001 to 2020 (APC, 1.22%; 95% CI, 2.50 to 0.20); overall AAPC was 3.89% (95% CI, 1.16 to 6.60). Men had consistently higher AAMRs than women across all years (period means, 244.9 vs 172.3 per 100,000). Non‑Hispanic (NH) Black older adults experienced the highest mean AAMR (271.1), followed by NH White (200.0), Hispanic (181.6), American Indian/Alaska Native (195.8), and Asian (149.2) populations. Regional rates were highest in the Midwest and South during the early 2000s, with declines thereafter; non‑metropolitan counties exhibited persistently higher AAMRs than metropolitan counties. Home and hospice deaths increased substantially over time, with a marked surge in 2020. State‑level AAMRs ranged from 104.7 (Utah) to 310.9 (Oklahoma). Conclusions: Among U.S. older adults with essential HTN and CAD, mortality surged around the turn of the millennium and then declined slowly through 2020, with substantial and persistent disparities by sex, race/ethnicity, geography, and urbanization. These findings underscore the need for renewed, equity‑focused strategies to improve blood pressure control, secondary prevention of CAD, and access to high‑quality cardiovascular care particularly for NH Black and rural populations.

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