This study aims to explore the long-term mortality trends in Hypertension-Associated Stroke in U.S. Adults, with attention to persistent disparities across demographics and regions.

Stroke and Hypertensive Diseases are among the leading causes of adult morbidity and mortality in the United States (U.S.), yet the long-term mortality associated with their coexistence remains underexplored.

We examined CDC-WONDER data on deaths related to Stroke (ICD-10: I60-I69) and Hypertensive Diseases (ICD-10: I10-I15) in adults aged ≥25 from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) were calculated and categorized by demographics and regions. Joinpoint regression was used to estimate APC and Average Annual Percent Change (AAPC).

From 1999 to 2023, a total of 1,743,885 deaths pertaining Hypertensive-associated Stroke were recorded in adults (≥25 years). AAMR showed a rise from 2.82 in 1999 to 36.88 in 2023 (AAPC: 0.5502, 95% CI: -0.1616 to 1.2671; p = 0.12). Men showed an upward trend in AAMRs than women from 1999 to 2023 with (2.73 to 38.67 vs. 2.78 to 34.78). However, women experienced an overall higher number of deaths compared to men (1,011,778 vs. 732,107). Among the non-hispanic (NH) population, NH Black individuals had highest AAMR overall from 1999 to 2023 (8.95 vs. 58.24) while (NH) Asian had lowest (3.46 vs 28.12). However, (NH) White had the greatest deaths recorded (1,258,893). Geographically, the South recorded the greatest deaths (692,042) with a sharp rise in AAMR from 1999 to 2023 (3.53 vs. 44.03). AAPC was greatest for South (0.8627). Non-metropolitan areas had higher overall AAMR compared to metropolitan areas (32.64 vs. 29.85).

The overall mortality from Hypertensive-associated Stroke has risen over time, with persistent disparities by sex, year, race, and region. These findings highlight the need for equity-focused interventions in high-risk and underserved populations.