Abstract Body (Do not enter title and authors here): Background:
Hypertension causes about 70% of strokes worldwide and raises the risk of cerebral small vessel disease by 1.5 times, the major cause of stroke and vascular dementia. This study analyzes CDC data (1999–2020) to evaluate long-term stroke mortality linked to hypertension and identify disparities by sex, race, and region to inform public health strategies.

Methods:
CDC WONDER data (1999–2020) for adults aged 25–85+ were analyzed. Deaths were identified using ICD-10 codes I10–I15 (hypertensive diseases) and I60–I69 (cerebrovascular diseases). Age-adjusted mortality rates (AAMR) per 100,000 were stratified by sex, race/ethnicity, census region, state, and urbanization. Joinpoint regression assessed trends. Annual percentage changes (APC) were calculated via Monte Carlo permutation with 95% confidence intervals using the Parametric Method. Two-tailed t-tests determined statistical significance.

Results:
From 1999 to 2020, stroke mortality due to hypertension (ages 25–85+) fluctuated across demographics and regions. AAMR increased from 217.79 in 1999 to 382.49 in 2020. Both sexes saw a rise from 1999–2001 (males APC = 7.81, females = 7.13), a decline through 2010 (males = -1.08, females = -1.70), then a steady increase until 2018 (males = 1.23, females = 0.30). Between 2018–2020, AAMR rose sharply—males (APC = 12.99), females (APC = 11.08). All racial groups showed varied trends until 2018, then a significant rise from 2018–2020, led by Hispanics (APC = 21.49), followed by Black or African Americans (17.15), Asian or Pacific Islanders (14.69), and American Indians (14.65). Regionally, the Midwest had the highest increase (APC = 14.37), followed by the Northeast (13.30), South (12.45), and West (9.52).Rural and urban areas showed a similar fluctuating pattern, with a sharp rise after 2018. The greatest increases occurred in large metro areas (APC = 14.33) and nonmetro micropolitan regions (12.28), with the smallest in medium metro areas (10.39). State-level AAMRs were highest in the District of Columbia (381.14) and Oklahoma (368.77), and lowest in Massachusetts (177.26) and Utah (187.11).

Conclusion:
Stroke mortality from hypertensive disease rose sharply after 2018 across all groups. Males, Hispanics, Midwestern residents, and those in large metros saw the steepest increases. These findings call for urgent, targeted public health strategies to address growing disparities and reduce hypertension-related stroke deaths.