Abstract 4368735: Shifting Patterns in Essential Hypertension Mortality in the United States Before and After the COVID-19 Pandemic

Background: Essential hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality. The COVID-19 pandemic introduced major disruptions in chronic disease care, but its impact on hypertension-specific mortality at the population level remains underexplored. Methods: We used the CDC WONDER Multiple Cause of Death database to extract mortality data for essential hypertension (ICD-10 I10) from 2016–2023. We compared pre-COVID (2016–2019) and post-COVID (2020–2023) periods. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated using bridged-race census estimates and stratified by sex, race/ethnicity, age group, state, urbanization, year, and place of death. Results: There were 89,835 deaths pre-COVID and 107,425 deaths post-COVID, with the national AAMR increasing from 5.61 to 6.44 per 100,000. Increases were observed across all demographics: male AAMR rose from 5.74 to 6.76 and female from 5.34 to 5.97. Black individuals had the highest AAMR in both periods (9.20 to 10.66), while White individuals had the lowest (5.24 to 6.03). Adults ≥65 accounted for the majority of deaths; among them, the 65–74 group rose from 13.1 to 16.2 and the 75–84 group from 32.7 to 36.4. Geographically, Mississippi and West Virginia had the highest AAMRs in both eras, while Colorado and Utah consistently had the lowest. Urban-rural differences persisted, with Non-Core areas experiencing the highest AAMR post-COVID (6.16 to 6.95). Notably, the proportion of deaths occurring at home increased from 37.3% to 43.4%, while inpatient deaths remained stable around 16%, indicating a shift toward out-of-hospital deaths. Conclusion: Essential hypertension mortality increased following the COVID-19 pandemic, with widening disparities by sex and race and a marked shift toward out-of-hospital deaths. These findings highlight the urgent need to strengthen outpatient hypertension management and community health strategies, especially in vulnerable populations.