Abstract Body (Do not enter title and authors here): Background: Stroke, a major cause of death and disability, is closely linked to hypertension. This study analyzes trends in mortality from stroke with hypertension as a contributing factor in adults aged 65+ in the U.S. over the past two decades.

Methods: Data were extracted from the CDC WONDER database for 2000-2023, focusing on deaths from hypertension-related stroke. Mortality rates were calculated using both crude and age-adjusted mortality rates (AAMRs). Joinpoint regression was used to calculate annual percent changes (APC).

Results: From 2000 to 2023, 356,432 deaths were recorded due to hypertension-related stroke. The age-adjusted mortality rate (AAMR) decreased from 48.7 in 2000 to 19.4 in 2023. Mortality rates declined steadily, with a slight increase from 2018 to 2021 (APC: 0.53), followed by a sharp decline from 2021 to 2023 (APC: -11.09). In females, the AAMR decreased from 51.9 in 2000 to 19.8 in 2023, with the largest decline from 2012 to 2018 (APC: -7.12). In males, the AAMR dropped from 41.1 in 2000 to 18.3 in 2023, with a notable decrease from 2012 to 2018 (APC: -6.39). For racial groups, the AAMR for Black or African American individuals decreased from 85.7 in 2000 to 29.2 in 2023, for White individuals from 45.4 to 18.8, and for Hispanic individuals from 42.9 to 16.6. Regional trends showed significant declines in the Midwest (APC: -6.64), Northeast (APC: -5.15), and West (APC: -11.51).

Conclusion: Hypertension-related stroke mortality has significantly declined, though disparities persist, especially among racial minorities and non-metropolitan areas. Continued targeted public health efforts are necessary to address these disparities and further reduce mortality.