Abstract Body: Background: Neoplasms are a major cause of death in the United States, yet the impact of coexisting conditions like hypertension on neoplasm-related mortality remains poorly characterized. Understanding this relationship can shed light on broader patterns of chronic disease burden across diverse U.S. populations.

Methods:
We analyzed U.S. mortality data (2018–2023) from the CDC WONDER database, including deaths where neoplasms were the underlying cause and essential or secondary hypertension was a contributing cause. Age-standardized death rates and annual percentage change (APC) were calculated and stratified by age, sex, year, U.S. Census region, state, education level, and urbanization status.

Result:
The age-adjusted neoplasm mortality with hypertension as a contributing cause rose at an annualized rate of 1.94% pre-COVID (2018–2019) and 4.40% during the COVID era (2020–2023). From 2018 to 2022, the highest increase was observed among Asian Indians (+11.2%), followed by Black (+7.2%) and American Indian or Alaskan Native (+6.0%) populations. From 2018 to 2022, the South showed the highest increase in APC in neoplasm deaths with hypertension as a contributing cause (+8.8%), followed by the West (+5.3%), Midwest (+5.0%), and Northeast (+4.2%). Based on urbanization level, the highest increase observed in medium metro areas (+8.4%), followed by micropolitan nonmetro (+6.8%) and large fringe metro areas (+6.7%). Based on education level, the highest increase in APC among individuals with an associate degree (+6.7%), followed by those with doctorate or professional degrees (+6.1%) and bachelor's degrees (+6.1%), while a decline was noted among those with education up to 8th grade (−3.7%). Based on age group, the highest rise occurred among individuals aged 35–44 years (+8.1%), followed by 25–34 years (+6.6%).
Conclusion:
Disproportionate rises in neoplasm mortality with hypertension—from younger adults to metro and educated populations—reflect a shifting epidemiologic pattern that challenges conventional risk profiles and underscores the urgency for integrated hypertension surveillance in oncology care and policy planning.