Although hypertension (HTN) typically has no symptoms, it has serious health consequences. For instance, according to a study conducted in the United States (US), the rate of deaths related to hypertension have risen by 72% and 20% in rural and urban areas, respectively. The details of the study and the findings were presented at the American College of Cardiology’s Annual Scientific Session together with World Congress of Cardiology (ACC20/WCC).1
The investigators have analyzed the age-adjusted mortality rates attributed to HTN-related cardiovascular (CV) deaths from the death record of the Center for Disease Control and Prevention over the period 2007 to 2017. HTN-related CV disease (CVD) mortality was defined as death where CVD was the underlying cause of death and HTN was the contributing cause of death. HTN included essential HTN, hypertensive heart and/or renal disease, and secondary HTN. Subgroup analysis included sex, US census regions, age (45-55, 55-64, 65-74 years) and urbanization status. Urban was defined as large central metro or large fringe metro. Rural was defined as micropolitan or noncore.2,3
HTN is defined by the American Heart Association’s High Blood Pressure in Adults Guideline as blood pressure consistently above 130mmHg systolic pressure or 80mmHg diastolic pressure and is a leading risk factor for heart disease. Over time, HTN causes damage to the arteries and restricts blood flow, which can weaken heart muscle or lead to CV events such as heart attack or stroke. The current study revealed a dramatic increase in HTN-related deaths nationwide between 2007 and 2017.2,3 The increase was most pronounced in the rural South where the individuals showed a 2.5-fold higher HTN-related death rate compared to the other regions. Age-adjusted death rates increased in the rural South from 23.9 deaths per 100,000 people in 2007 to 39.5 deaths per 100,000 people in 2017.2,3
“This is a public health emergency that has not been fully recognized,” said Dr. Lakshmi Nambiar, CVD fellow at the University of Vermont Larner College of Medicine and the study’s lead author. Dr. Nambiar also pointed out, “Hypertension-related CV deaths are rising in the US across all age groups, all regions and in both urban and rural populations.2,3
Although the death rates increased for all age groups over time, an absolute highest rate of death is observed in the oldest patient groups (age 65-74) at every time point. While HTN-related CVD death rates among men were overall higher compared to women for all time points, both sexes showed significant rates of increasing death rate over time (p<0.001).2
The highest death risk population was identified in the rural South which demonstrated an age adjusted 2.5-fold higher death rate compared to other regions. The urban South also demonstrated increasing HTN-related CVD death rates over time: Age-adjusted death rates in the urban South has increased by 27% compared to all other urban regions.2,3
These findings highlighted the increasing challenge of HTN-related CVD death, especially in the rural South and reinforced the population-wide importance of the new hypertension guidelines. Differences in CV outcomes in rural populations were due to obesity, diabetes, and disparities in the healthcare access/delivery. The investigators suggested further investigation into racial disparities.