Abstract Body: Introduction:
Hypertension is a leading contributor to cardiovascular mortality in the United States, with postmenopausal women at higher risk. The COVID-19 pandemic may have further influenced hypertension-related mortality through healthcare disruptions. This study aimed to analyze national mortality trends using the CDC Wonder database.

Hypothesis:
What are the long-term trends and demographic disparities in hypertension-related mortality among postmenopausal women in the United States, and was there a significant change in mortality during the COVID-19 period?

Aims:
To examine national trends and demographic disparities in hypertension-related mortality among postmenopausal women in the United States from 1999–2024 and assess potential changes during the COVID-19 period.

Methods:
A retrospective analysis from CDC-WONDER Multiple Cause of Death database from 1999-2024 was conducted for mortality due to hypertension, using ICD-10 code I10-I15 in post-menopausal women (≥55 years of age). Age-adjusted mortality rates (AAMRs) per 100,000 were standardized to the U.S population. Join point regression analysis estimated average annual percent change (AAPC) in mortality trends for age, race, urbanization, and geographic region, with statistical significance set at p< 0.05.

Results:
A total of 5,376,152 deaths due to hypertension among postmenopausal women were analyzed from 1999 to 2024. The overall age-adjusted mortality rate (AAMR) increased from 180.37 to 580.96 per 100,000(1999-2024), with AAPC of 3.79% (95% CI: 2.87–4.58; p < 0.001). A significant increase was observed during 2018–2021 (APC = 12.64%; 95% CI: 6.84–16.03; p = 0.0068), coinciding with the COVID-19 period. Mortality increased progressively with age, with the highest rates among older women. Non-Hispanic Black women had the highest mortality rate, while AAMRs of rural areas (449.45) exceeded those of urban areas (420.49). The Southern U.S. showed the steepest increase (AAPC: 4.49%; 95% CI: 3.44–5.42).

Conclusion:
This study shows an increase in hypertension-related mortality among postmenopausal women, with notable demographic and geographic disparities and a marked rise during the COVID-19 period, highlighting the need for improved hypertension prevention and management in high-risk populations.