# Mortality Due to Aortic Dissection in Adults With Primary Hypertension: A Nationwide Analysis Over Two Decades

## TL;DR

This study examines how aortic dissection mortality has changed over two decades in US adults with hypertension, highlighting disparities and trends.

## Contribution

The study provides a nationwide analysis of aortic dissection mortality trends in hypertensive adults over two decades using CDC data.

## Key findings

- Males had higher age-adjusted mortality rates than females throughout the study period.
- Aortic dissection mortality increased in rural areas from 2010 to 2020, while urban areas saw stabilization.
- Hawaii, Oregon, and Oklahoma had the highest state-level age-adjusted mortality rates.

## Abstract

Hypertension is a key risk factor for aortic dissection (AD). AD, if left untreated, carries significant mortality rates. Our aim is to analyse trends in mortality due to AD in adults with primary hypertension in the United States (US).

We used the CDC WONDER database to extract mortality data for patients with primary hypertension who died due to AD. Age‐adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were extracted per 100 000 persons. Annual percentage changes (APCs) and average APCs (AAPCs) in AAMRs and CMRs were calculated using Joinpoint regression.

From 1999 to 2020, a total of 13 128 deaths due to AD were reported in patients with primary hypertension in the US. Males displayed a higher overall AAMR (0.3) than females (0.2) throughout the study period. Slight regional variations were observed, with the West showing the highest overall AAMR (0.4), followed by the Midwest (0.3), and the Northeast and South (0.2). In urban areas, AAMRs were higher than in rural areas until 2008. From 2009 to 2020, AAMRs remained stable in urban areas (0.3) but increased in rural areas from 2010 to 2020 (4.7). The highest state‐level AAMRs were observed in Hawaii, Oregon, and Oklahoma.

Significant differences were observed in AAPCs compared to AD‐related mortality trends in the general population. Mortality trends revealed an initial decline followed by a gradual rise. Clinicians should focus on high‐risk groups and raise awareness about the disease in these populations.

From 1999 to 2020, aortic dissection–related mortality in US adults with hypertension showed an initial rise, followed by stabilization. Mortality was highest in males, older adults, NH Black individuals, and the Western US, highlighting disparities and the need for improved hypertension control in high‐risk groups.