Hypertension Mortality Rose Significantly from 1999 to 2019

From 1999 to 2019, hypertension mortality rose significantly among US adults 45 or over that reported diabetes diagnoses, according to a study published in Diabetes Epidemiology and Management.¹

“Hypertension, or the ‘silent killer’, is high blood pressure where blood pressure exceeds 140/90 mmHg,” wrote authors of the study. “If left untreated, hypertensive patients are susceptible to disability, poor quality of life, or even fatal cardiac diseases like ischemic heart disease, heart failure, and cerebrovascular diseases.”

Both hypertension and diabetes are significantly prevalent among US adults. Beginning with the diabetes prevalence among US patients, up to 11.6% of Americans at any age have reported a diagnosis. Furthermore, 8.7 million US adults have met the criteria for having diabetes but were not aware or did not report it.²

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Hypertension, on the other hand, impacts even more US adults, especially those at increased risk of morbidity or mortality. Data show that hypertension rates among US adults are up to nearly 120 million.³

Researchers explored hypertension as a contributing cause of death while diabetes diagnoses were considered underlying causes of death. | image credit: ruslee / stock.adobe.com

Despite the known links between hypertension, diabetes, and increased mortality risks, the collective understanding of hypertensive mortality rates among patients with diabetes is currently lacking.¹

Older age, genetics, obesity, sedentary lifestyle, high-salt diet, alcohol consumption, environmental risk factors, and most importantly for the current study, diabetes, are all risk factors for a patient’s development of hypertension. While hypertension is known to lead to cardiovascular disease, which is often followed by increased mortality, researchers of the current study wanted to dive deeper into the survival rates among a specific subset of patients with hypertension.

“Hypertension-related mortality trends remain unexplored in patients with diabetes,” they continued.¹ “The existing literature highlights the need for a comprehensive analysis to identify disparities and the underlying factors contributing to these disparities over time. Our study meticulously investigates regional and demographic mortality trends utilizing the Centers for Disease Control and Prevention (CDC WONDER) database linked to hypertensive diseases among middle-aged (45-64 years) and older adult (≥65 years) patients with diabetes from 1999 to 2020.”

While using CDC data to explore mortality rates and risk factors in this study, researchers only explored diabetes as an underlying cause of death and hypertension as a contributing cause. Despite both being factors that led to mortality, a contributing cause of death is considered a non-immediate factor contributing to a fatal outcome not related to a disease or condition that caused death.⁴ Underlying causes of death, however, are defined as diseases or injuries that introduced individuals to the process leading directly to death.⁵

Researchers explored the data and separated study participants by race, age, place of death, urban or rural classification, and more. The analysis included individuals 45 to 85 years old and up, separated into groups of 10-year intervals. They then used CDC data to determine participants’ age-adjusted (AAMRs) and crude mortality rates (CMRs).

Throughout the 20-year study period, researchers uncovered a total of 538,649 deaths (50.8% women; 28.94% aged 75-84 years) in the US due to hypertensive diseases among patients with diabetes from 1999 to 2019.

Regarding the study population’s change in mortality rates, where higher numbers constitute greater mortality, the overall mortality in this analysis increased significantly throughout the study period. For AAMR, rates began at 8.3 in 1999 and increased to 25.76 in 2019, with researchers observing a steady increase year over year.

CMRs for the study population’s 5 age groups separated by 10-year intervals were highest among participants over 84 years old, at 105.54, gradually decreasing as ages were reduced. Men saw greater increases in mortality rates throughout the period when compared with women, while AAMRs were highest among Black patients and the greatest increase in mortality was observed among American Indian patients.

“There was an abrupt increase in mortality rates from 1999 to 2001, following which a progressive increase was observed until 2019,” wrote the authors.¹ “This pattern was largely consistent for both genders, with men having higher overall AAMR than females. Second, non-Hispanic Blacks had the highest AAMR compared with other racial groups in this age strata of ≥45 years.”

Above all other findings in the analysis, researchers uncovered a significant increase in AAMRs and CMRs throughout the 1999-2019 time period. While disparities were uncovered among specific age groups, races, and locations, researchers suggested that further research and public health strategies can help bolster understanding of hypertension-related mortality among all populations with diabetes.

“This nationwide study reveals a rising trend in hypertensive disease-related mortality among US adults aged 45 and above with diabetes from 1999 to 2019, with notable disparities across sex, race, region, urbanization, and states,” they concluded.¹ “These findings highlight the urgent need for targeted interventions, improved health care access, and tailored public health strategies to address the growing burden of hypertension-related mortality in populations with diabetes.”

READ MORE: Diabetes Resource Center

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References

1. Raza A, Kalpina F, Ijaz S, et al. Hypertensive disease mortality trends among middle-aged and older adults with diabetes mellitus in the United States, 1999-2019: a nationwide analysis. Diabetes Epidemiology and Management. Published online July 30, 2025:100277. https://doi.org/10.1016/j.deman.2025.100277

2. National diabetes statistics report. CDC. May 15, 2024. Accessed September 3, 2025. https://www.cdc.gov/diabetes/php/data-research/index.html

3. Estimated hypertension prevalence, treatment, and control among U.S. adults. May 12, 2023. Accessed September 3, 2025. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html

4. Glossary: contributory cause of death. Eurostat. Accessed September 3, 2025. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:Contributory_cause_of_death

5. Cause of death. CDC. June 9, 2025. Accessed September 3, 2025. https://www.cdc.gov/nchs/hus/sources-definitions/cause-of-death.htm