To project national mortality trends for epilepsy and hypertension in the United States through 2035 and to analyze disparities by sex, race, census region, and urbanization level.

Epilepsy and hypertension are major comorbid conditions with a significant public health impact. Understanding their combined mortality trajectory is essential for proactive healthcare strategies.

We analyzed CDC Wonder data from 1999–2020. Age-adjusted mortality rates (AAMRs) were log-transformed and modeled using Autoregressive Integrated Moving Average (ARIMA) methodology to forecast rates through 2035. Optimal model parameters were selected automatically using a stepwise algorithm guided by the Bayesian Information Criterion. Model adequacy was confirmed with Ljung-Box tests for residual autocorrelation. Trends were quantified using annual percentage change (APC).

The deaths from 1999–2020 were 10,702. Forecasts project a continued sharp rise for all groups. The female AAMR is forecasted to increase from 0.38 in 2021 to 1.68 by 2035 (average APC 2021-2035: 11.24%). The male AAMR is projected to rise from 0.44 to 2.01 (average APC: 11.48%). Profound racial disparities were observed; the AAMR for Black individuals is forecasted to rise from 0.71 to 2.18 (average APC: 8.50%), while the AAMR for White individuals is projected to increase from 0.34 to 1.43 (average APC: 10.76%). All census regions and urbanization levels showed significant forecasted increases, with average APCs ranging from 9.83% (West) to 12.57% (South) and from 10.35% (large central metro) to 12.83% (small metro).