Abstract Body: Introduction: Type 2 diabetes (T2D) and hypertension are two of the most prevalent and interrelated cardiometabolic conditions in the United States, jointly exacerbating the risk for cardiovascular disease, renal failure, and premature death. Despite this clinical intersection, national trends in mortality due to T2D with comorbid hypertension remain poorly defined.

Hypothesis: We hypothesized that mortality attributable to T2D with comorbid hypertension has risen significantly over the past two decades and exhibits pronounced disparities across sex, race, geographic location, and urbanization level.

Methods: We analyzed national mortality data from the CDC WONDER database for adults aged >35 years from 2000 to 2020. T2D (ICD-10: E11.0–E11.9) was identified as the underlying cause of death, with hypertensive disease (I10–I15) listed as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and Joinpoint regression was used to assess trends and annual percent change (APC).

Results: A total of 180,944 deaths were attributed to T2D with comorbid hypertension. AAMRs rose significantly from 2.5 (95% CI, 2.4–2.5) in 2000 to 9.1 (95% CI, 8.9–9.2) in 2020, with an APC of 5.5% (p<0.001). Males exhibited a higher cumulative AAMR than females (5.8 [95% CI, 5.8–5.8] vs. 4.3 [95% CI, 4.3–4.3]). By race, American Indians (9.1 [95% CI, 8.7–9.5]) and African Americans (8.9 [95% CI, 8.8–9.0]) had the highest AAMRs, followed by Asians (5.6 [95% CI, 5.5–5.7]) and White individuals (4.5 [95% CI, 4.5–4.5]). AAMRs were comparable in large central metropolitan regions and rural noncore regions (5.2 [95% CI, 5.2-5.2] vs. 5.2 [95% CI, 5.1-5.3]), but lowest in large fringe metropolitan areas (4.1 [95% CI, 4.0–4.1]). Regionally, the West had the highest AAMR (6.3 [95% CI, 6.3–6.4]), followed by the South (5.1 [95% CI, 5.1–5.2]), Midwest (5.1 [95% CI, 5.0–5.1]), and Northeast (3.0 [95% CI, 2.9–3.0]).

Conclusions: T2D-related mortality in individuals with comorbid hypertension has more than tripled since 2000, disproportionately affecting males, American Indians, and African Americans. Geographic disparities persist, with the highest mortality burden observed in the Western region of the United States. These findings underscore the urgent need for targeted prevention, early detection, and aggressive risk factor management in high-risk cardiometabolic populations.