Talks
Presenting Author Academic/Professional Position
Resident
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Other
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Internal Medicine
Presentation Type
Oral Presentation
Discipline Track
Community/Public Health
Abstract Type
Research/Clinical
Abstract
Background: Heart disease mortality has declined nationwide, but Texas continues to experience higher rates than the United States overall. At the same time, hypertensive heart disease (HHD) has become more prominent within cardiovascular mortality statistics. Whether this shift reflects a growing hypertension-driven contribution to the Texas–U.S. gap has not been well quantified. We compared long-term trends in HHD mortality and the presence of HHD on death certificates among heart disease deaths in Texas versus the United States.
Methods: We analyzed CDC WONDER Underlying Cause of Death and Multiple Cause of Death files, 1999–2020, restricted to decedents aged ≥25 years. HHD was defined as ICD-10 I11.*. Underlying heart disease deaths were defined using ICD-10 I00–I02, I05–I09, I11, I13, and I20–I51. For Texas and the United States, we extracted annual deaths and age-adjusted mortality rates (per 100,000; 2000 U.S. standard) for: (1) underlying-cause HHD; (2) underlying heart disease; and (3) underlying heart disease with any mention of HHD. We calculated Texas-to-U.S. rate ratios and the proportion of heart disease deaths with HHD mention.
Results: Underlying-cause HHD mortality increased in both settings but grew more in Texas: 12.06 to 27.90 per 100,000 from 1999 to 2020 (+131%) versus 12.87 to 24.73 nationally (+92%). The Texas-to-U.S. HHD rate ratio shifted from 0.94 in 1999 to 1.13 in 2020. Over the same period, underlying heart disease mortality declined through 2019 and increased in 2020 (Texas 251.90 to 268.11; U.S. 161.52 to 168.19). The share of heart disease deaths with any HHD mention climbed from 2.7% to 20.7% in Texas and from 2.8% to 14.9 nationally.
Conclusions: These findings suggest that Texas’s persistent excess heart disease mortality is increasingly linked to hypertension-associated cardiac disease. While overall heart disease death rates declined over two decades, HHD mortality rose steadily, and HHD became progressively more common on heart disease death certificates, especially in Texas. The growing divergence in HHD-related measures implies more than a uniform national shift in coding or case mix and points toward a growing hypertension-driven pathway that may be targeted for prevention. Interpretation should account for the limits of death certificate data, including potential misclassification of underlying cause and temporal changes in documentation practices; however, the consistency across underlying-cause trends and multiple-cause mentions supports a genuine signal. Strengthening blood pressure prevention, control, and reducing progression to hypertensive cardiomyopathy and heart failure may be key strategies to narrow the Texas–U.S. heart disease mortality gap.
Recommended Citation
Loayza Pintado, Jose J.; Lopez Jesus, Angelica; Calderon, Aura; Aboytes Trevino, Jorge; and Hernandez, Daniela, "From Risk Factor to Cause of Death: Hypertensive Heart Disease and the Changing Composition of Heart Disease Mortality in Texas Compared with the United States, 1999–2020" (2026). Research Symposium. 5.
https://scholarworks.utrgv.edu/somrs/2026/talks/5
Included in
From Risk Factor to Cause of Death: Hypertensive Heart Disease and the Changing Composition of Heart Disease Mortality in Texas Compared with the United States, 1999–2020
Background: Heart disease mortality has declined nationwide, but Texas continues to experience higher rates than the United States overall. At the same time, hypertensive heart disease (HHD) has become more prominent within cardiovascular mortality statistics. Whether this shift reflects a growing hypertension-driven contribution to the Texas–U.S. gap has not been well quantified. We compared long-term trends in HHD mortality and the presence of HHD on death certificates among heart disease deaths in Texas versus the United States.
Methods: We analyzed CDC WONDER Underlying Cause of Death and Multiple Cause of Death files, 1999–2020, restricted to decedents aged ≥25 years. HHD was defined as ICD-10 I11.*. Underlying heart disease deaths were defined using ICD-10 I00–I02, I05–I09, I11, I13, and I20–I51. For Texas and the United States, we extracted annual deaths and age-adjusted mortality rates (per 100,000; 2000 U.S. standard) for: (1) underlying-cause HHD; (2) underlying heart disease; and (3) underlying heart disease with any mention of HHD. We calculated Texas-to-U.S. rate ratios and the proportion of heart disease deaths with HHD mention.
Results: Underlying-cause HHD mortality increased in both settings but grew more in Texas: 12.06 to 27.90 per 100,000 from 1999 to 2020 (+131%) versus 12.87 to 24.73 nationally (+92%). The Texas-to-U.S. HHD rate ratio shifted from 0.94 in 1999 to 1.13 in 2020. Over the same period, underlying heart disease mortality declined through 2019 and increased in 2020 (Texas 251.90 to 268.11; U.S. 161.52 to 168.19). The share of heart disease deaths with any HHD mention climbed from 2.7% to 20.7% in Texas and from 2.8% to 14.9 nationally.
Conclusions: These findings suggest that Texas’s persistent excess heart disease mortality is increasingly linked to hypertension-associated cardiac disease. While overall heart disease death rates declined over two decades, HHD mortality rose steadily, and HHD became progressively more common on heart disease death certificates, especially in Texas. The growing divergence in HHD-related measures implies more than a uniform national shift in coding or case mix and points toward a growing hypertension-driven pathway that may be targeted for prevention. Interpretation should account for the limits of death certificate data, including potential misclassification of underlying cause and temporal changes in documentation practices; however, the consistency across underlying-cause trends and multiple-cause mentions supports a genuine signal. Strengthening blood pressure prevention, control, and reducing progression to hypertensive cardiomyopathy and heart failure may be key strategies to narrow the Texas–U.S. heart disease mortality gap.
