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

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.