The hidden epidemic: Hypertension-related mortality surges amongst younger adults in the United States.

Background: The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

Methods: Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

Results: Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

Conclusion: HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.