Leading Causes of Death Among US Adults With and Without Hypertension: Data From the REGARDS Study

A substantial proportion of adults with hypertension die from causes other than cardiovascular disease (CVD), but the frequencies are unknown.

We calculated the frequency of causes of death for adults with and without hypertension using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which enrolled non-Hispanic Black and White adults aged ≥ 45 years in 2003-2007. Participants were followed until death or 31 December 2019. Blood pressure (BP) was measured at baseline and at a follow-up examination in 2013-2016. Hypertension was defined as systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg, or self-reported antihypertensive medication use, and modeled a time-varying exposure. The outcome was the adjudicated underlying cause of death, determined from all available information, including death certificates, medical records, autopsy reports, and interviews with proxies or next of kin.

There were 8,933 deaths among 23,622 participants with hypertension and 1,709 deaths among 5,744 participants without hypertension over a median 8.1 years of follow-up. Among participants who died, the most common causes of death were CVD (31.2%), cancer (22.1%), and infection (11.6%) among participants with hypertension and cancer (29.8%), CVD (23.2%), and dementia (11.8%) among participants without hypertension. Among participants with and without hypertension, the 10-year cumulative incidence was 8.2% and 3.6% for CVD mortality, respectively, 5.8% and 4.9% for cancer mortality, and 2.8% and 1.5% for infection mortality, respectively.

Among adults with hypertension, a majority of deaths were from non-CVD causes, including one-third of deaths from cancer and infection.