Abstract Body: Background: Cardiac arrest and hypertension are leading contributors to mortality among adults in the United States(US). Using CDC WONDER data from 1999 to 2020, this study examined national mortality trends and disparities across demographic and geographic groups in adults aged 25 and older in the US.

Hypothesis: We hypothesized that mortality due to cardiac arrest with hypertension has increased over time and that significant disparities exist by sex, race/ethnicity, and geographic region among US adults aged ≥25 years.

Methods: A retrospective analysis was performed using the CDC WONDER database from 1999–2020 for adults aged ≥25 years. Deaths listing cardiac arrest (ICD-10: I46) and hypertension (ICD-10: I10–I15) as contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and trends were assessed stratified by sex, age group, race/ethnicity, census region, urbanization level, state, and place of death. Joinpoint regression was used to determine annual percent change (APC) and average annual percent change (AAPC).

Results: Between 1999 and 2020, a total of 1,337,722 deaths were reported among US adults aged ≥25 years with both cardiac arrest and hypertension listed as causes of death. The AAMR increased from 13.2 in 1999 to 36.8 in 2020, with an AAPC of 3.59% (95% CI: 2.74–4.44; p < 0.000001). Notably, AAMR significantly increased from 1999 to 2001 (APC: 24.2%; 95% CI: 14.2–35.0) and then again from 2018 to 2020 (APC: 10.2; 95% CI: 5.7–14.9). Men had higher AAMRs than women (men: 31.1 vs. women: 24.9), with a steeper increase (AAPC: 5.09 ) compared to women ( AAPC: 3.01). Racial disparities showed the highest AAMRs in non-Hispanic (NH) Blacks (56.6), followed by Hispanics (37.1), NH Asians/Pacific Islanders (35.6), NH American Indians/Alaska Natives (26.4), and NH Whites (23.4). Geographically, AAMRs varied substantially across states, ranging from 7.8 in Minnesota to 89.3 in Mississippi. The West had the highest regional AAMR (41.8). Mortality rates were slightly higher in metropolitan areas (28.6) compared to non-metropolitan areas (25.1). Across age groups, adults aged ≥65 years had the highest AAMR (117.4). Most deaths occurred in medical facilities (603,544; 45.1%), followed by homes and long-term care settings.

Conclusions: From 1999 to 2020, AAMR involving cardiac arrest and hypertension have more than doubled, disproportionately affecting men, NH Black populations, and those in the Western region.