Abstract Body: Introduction: Hypertension (HTN) is a leading contributor to cardiovascular mortality, with already known racial disparities. However, just a few studies have evaluated temporal changes in HTN-related mortality across different racial and gender groups during the COVID-19 era. This study aimed to assess the changes in age-adjusted mortality rates (AAMR) for HTN-related deaths in the United States from 2018 to 2023, with a focus on racial and sex disparities and the pandemic’s impact.

Methods: This was a retrospective repeated cross-sectional analysis of U.S. national death certificate data from the CDC WONDER database from 2018 to 2023. All decedents with hypertension listed as an underlying or contributing cause of death (ICD-10 codes I10-I15) were included. Annual hypertension-related age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by race and sex. Comparisons between the pre-COVID (2018-2019) and post-COVID (2020-2023) periods were conducted using Welch’s t-test. Temporal trends in AAMR were evaluated using segmented linear regression to identify changes in slope before and after 2020. Annual percent changes (APCs) were derived from the model coefficients. Statistical significance was defined as P<0.05.

Results: From 2018 to 2023, HTN-related deaths rose across all racial groups. The highest overall AAMR was observed in Black individuals (52.8 in 2023 vs 45.9 in 2018; +14.9%). The greatest relative increase occurred in White individuals (30.2 in 2023 vs 21.8 in 2018; +38.5%). Joinpoint analysis in Black males showed a sharp pre-COVID increase (APC +11.4%) followed by post-COVID plateauing (APC -1.8%). Asian males and females were the only groups to exhibit continued increases post-COVID (APC +1.1% and +0.7%, respectively). In sex-stratified analysis, Black males had the highest AAMR throughout the study (59.9 pre-COVID; 65.1 post-COVID). Percent increases were less pronounced in Black individuals probably due to higher baseline mortality. Racial disparities persisted, with variation in trends across groups.

Conclusions: Hypertension-related mortality increased during the COVID-19 era across all races, with the highest absolute burden in Black Americans. Sex disparities persisted, with males consistently experiencing higher mortality than females. These findings highlight the need for tailored public health strategies that address both absolute and relative disparities in HTN outcomes across racial and sex groups.