Using CDC WONDER mortality data, investigators evaluated trends in deaths attributed to aortic dissection (AD) among adults with primary hypertension in the United States between 1999 and 2020. Age-adjusted mortality rates (AAMRs), crude mortality rates (CMRs), annual percentage changes (APCs), and average APCs (AAPCs) were calculated using Joinpoint regression. The results were published in Clinical Cardiology.

During the study period, 13,128 AD-related deaths occurred among individuals with primary hypertension. Males had higher overall AAMRs (0.3 per 100,000 persons) compared with females (0.2). Regional variation was observed, with the West demonstrating the highest AAMR (0.4), followed by the Midwest (0.3), and the Northeast and South (0.2). Urban AAMRs exceeded rural rates until 2008. From 2009 onward, urban rates remained stable at 0.3, whereas rural AAMRs increased from 2010 to 2020 (4.7). Hawaii, Oregon, and Oklahoma recorded the highest state-level AAMRs. Mortality trends demonstrated an initial decline followed by a gradual rise.

Limitations include reliance on death certificate–based data with potential misclassification, inability to distinguish AD subtypes, lack of treatment and comorbidity data, and absence of socioeconomic adjustment. Observational design precludes causal inference.

AD mortality in hypertensive adults showed demographic and geographic variation over time. Clinicians are encouraged to focus awareness efforts on high-risk populations.