J Natl Med Assoc. 2026 Jul 3:S0027-9684(26)00120-3. doi: 10.1016/j.jnma.2026.06.020. Online ahead of print.
ABSTRACT
BACKGROUND: Hypertension (HTN) remains a key contributor to adverse outcomes in older adults with Alzheimer's disease (AD), which itself is the seventh leading cause of death in the U.S., affecting over 120,000 Americans annually. The co-existence of these conditions significantly increases the risk of morbidity and mortality, and despite their strong relationship, long-term mortality trends accounting for both conditions have not been assessed. This study examines trends and disparities in AD mortality among older patients (aged ≥ 65 years) with HTN in the U.S. from 1999 to 2023.
METHODS: Mortality records of older patients listing AD as the primary cause of death and HTN as a contributing cause were evaluated from 1999 to 2023 using the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were computed per 100,000 population, and annual percent changes (APCs) were derived to assess temporal trends across different demographics and geographies.
RESULTS: Overall, 314,914 mortalities were attributed to AD in patients with HTN, with overall AAMRs increasing from 1999 (7.1) to 2023 (41.1). Females (AAMR: 31.6) experienced higher rates than males (AAMR: 20.7). Rates peaked among NH African Americans (AAMR: 31.8), followed by NH Whites (AAMR: 28.3) and Hispanics (AAMR: 22.3). Adults aged 85+ years (AAMR: 142.3) had higher rates compared with those aged 75-84 (AAMR: 25.1) and 65-74 years (AAMR: 2.5). Geographically, AAMRs were highest in the West region (AAMR: 31.5) and among non-metropolitan residents (AAMR: 27.9) compared to metropolitan residents (AAMR: 25.03). Trend analysis revealed statistically significant APCs (p < 0.05) across all evaluated demographic and geographic subgroups.
CONCLUSION: This sharp, six-fold rise in AD and HTN-related mortality highlights a compounding public health challenge. The significant disparities observed in the disproportionate burden on females, NH African Americans, and non-metropolitan residents likely reflect intersecting biological vulnerabilities and structural inequities in healthcare access. These findings stress the urgent need for targeted health policy strategies and the proactive clinical management of comorbid conditions to protect these high-risk populations.
PMID:42493280 | DOI:10.1016/j.jnma.2026.06.020