Abstract Body (Do not enter title and authors here): Introduction:
Hypertension (HTN) is a common cardiovascular disorder and a significant risk factor for heart failure (HF). While the detrimental relationship between HTN and HF is well-established, there has been limited research analysing long-term mortality trends specifically for HTN-induced HF.
Hypothesis/Objective:
This study analyses mortality trends associated with HTN-induced HF in the United States from 1999 to 2020 and projects these rates to 2030.
Methods:
We accessed the CDC WONDER database to analyse HTN-induced HF mortality among U.S. adults (≥75 years) from 1999 to 2020, utilising ICD-10 codes. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression was employed to assess changes in AAMRs using annual percent change (APC) and average annual percent change (AAPC). After ensuring trend stationarity, forecast analysis was conducted for 2020-2030 using the Autoregressive Intergrated Moving Average (ARIMA) model in STATA (version 17.0).
Results:
From 1999 to 2020, a total of 230,736 deaths due to HTN-induced HF were reported in the United States, yielding an overall AAMR of 51.92 (AAPC: 5.90). The AAMR initially showed an inclining trend from 1999-2001 (APC: 42.14, 95% CI: 26.88 to 52.12) and 2001-2013 (APC: 0.25, 95% CI: -1.28 to 1.17), followed by a significant increase from 2013-2020 (APC: 6.96*, 95% CI: 4.87 to 10.88). Females exhibited greater AAMR (54.47) compared to males (46.64). Among racial groups, Black or African Americans had the highest AAMR (73.49), while Asian or Pacific Islanders had the lowest (37.42). Regional disparities were also noted, with the West region having the highest AAMR (65.93) and the Northeast having the lowest (40.41). Rural residents had an AAMR more than urban residents (57.71 vs. 50.63). Compared to the AAMRs in 2020, forecasts project an increase in AAMRs of both genders by 2030. Rising trends are also anticipated across most racial and regional groups, excluding the Southern region (59.33).
Conclusion:
Mortality rates for HTN-induced HF significantly increased in the United States between 1999 and 2020, with a particularly sharp rise after 2013. This burden disproportionately affected female patients, Black or African American individuals, older adults, and residents of the Western and rural United States. These findings underscore the urgent need for targeted public health initiatives focused on improved HTN management and preventive interventions.