Hypertension is a leading contributor to cardiovascular morbidity and mortality, particularly among individuals with diabetes mellitus (DM). We aim to assess hypertensive mortality trends among middle-aged (45-64 years) and older US adults (≥65 years) with DM from 1999 to 2019.

The data was extracted from the CDC WONDER multiple-cause-of-death database using ICD-10 codes E10-E14 for DM as the underlying cause of death and I10-I15 for hypertensive diseases as the contributing cause. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals were used, stratified by sex, race/ethnicity, age group, and geographic region. AAMRs and CMRs were further analyzed using Joinpoint Regression to calculate annual percentage changes (APCs) and average APCs (AAPCs).

From 1999 to 2019, 538,649 deaths occurred among adults ≥45 years with DM and hypertension. Overall, AAMR increased from 8.30 to 25.76, showing an increasing trend with a 4.69% annual rise in mortality. Males (AAMR 25.16) demonstrated a higher burden and greater rise in mortality (AAPC: 5.83%) than females (AAMR 19.33; AAPC 3.52%). Non-Hispanic Blacks had the highest AAMR (52.79), while non-Hispanic Whites showed the steepest mortality increase (AAPC: 4.97%). The South and non-metropolitan areas exhibited the most significant regional mortality burden.

Hypertensive mortality among US adults with DM rose significantly from 1999 to 2019, with pronounced disparities by sex, race, geography, and urbanization. Targeted healthcare interventions and improved access to hypertension management in high-risk subpopulations are needed to mitigate this growing burden.