Evolving mortality trends in hypertension-associated ischemic heart disease among U.S. adults over two decades: a CDC wonder analysis (2000-2023).

This study aimed to evaluate national, demographic, and geographic trends in mortality associated with hypertension and ischemic heart disease (IHD) among U.S. adults from 1999 to 2023. Mortality data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Adults aged ≥15 years with hypertension (ICD-10: I10-I15) listed as a contributing cause and IHD (ICD-10: I20-I25) as the underlying cause of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percent change (APC) were calculated using Joinpoint regression, stratified by year, sex, race/ethnicity, U.S. Census region, and urban-rural classification. Between 1999 and 2023, 3,575,793 hypertension-associated IHD deaths were recorded. The overall AAMR rose modestly through 2018 (APC = 0.4%; 95% CI, 0.1-0.6), sharply increased from 2018-2021 (APC = 10.3%; 95% CI, 7.7-11.9), and declined thereafter till 2023 (APC = -4.4%; 95% CI, -7.3 to -1.7). Men consistently exhibited nearly twice the mortality rate of women, and Black Americans experienced the highest AAMRs across racial/ethnic groups. Regionally, the South showed the greatest burden, while rural areas had approximately 20% higher mortality than metropolitan regions. Hypertension-associated IHD mortality in the U.S. demonstrates a U-shaped temporal pattern declining until the late 2010s, surging during the COVID-19 era, and only partially improving thereafter. Persistent disparities by sex, race, and geography underscore the urgent need for renewed, equitable prevention strategies targeting hypertension control and cardiovascular risk reduction nationwide.