Hypertension-related stroke vs atrial fibrillation-related stroke: a comparative mortality and outcome analysis using CDC WONDER

Document Type

Conference Proceeding

Publication Date

11-5-2025

Publication Title

Eur Heart J

Keywords

adolescent, adult, aged, atrial fibrillation, bleeding, California, cause of death, cerebrovascular accident, complication, conference abstract, crude mortality rate, disability, epidemiology, female, gender, groups by age, high risk population, Hispanic, human, hypertension, incidence, major clinical study, male, metropolitan area, middle aged, mortality, mortality rate, risk factor, treatment outcome, treatment response

Abstract

Background: Stroke remains a leading cause of mortality and disability, with hypertension (HTN) and atrial fibrillation (AF) being two major risk factors. While both conditions contribute to stroke incidence, their impact on mortality and outcomes differs due to variations in pathophysiology, treatment responses, and secondary complications. Purpose: This study utilizes CDC WONDER data to compare mortality and outcomes in HTN-related stroke versus AF-related stroke. By analyzing trends across demographics, geographic regions, and age groups, the findings aim to identify high-risk populations and inform targeted interventions for reducing stroke burden and improving patient outcomes. Methods: Using CDC WONDER data, we calculated AAMRs per 100,000 individuals aged 35+ who died from stroke with hypertension (I10, I11.9, I12.9, I13.9) or atrial fibrillation (I48) as multiple causes of death (MCD). HTN-related stroke deaths included ischemic and hemorrhagic subtypes (I60.8, I60.9, I61.8, I61.9, I63.0-I63.9, I64), while AF-related stroke deaths encompassed cerebral infarctions (I63.0-I63.9, I64). Data were analyzed across ten-year age groups. Joinpoint regression assessed APC and AAPC in mortality trends. Results: From 1999 to 2020, age-adjusted mortality rates (AAMRs) for atrial fibrillation-related stroke (AF-stroke) fluctuated between 9.88 and 11.37, peaking at 11.04 in 2020 (AAPC: -0.39, 95% CI: -0.74 to -0.03). AAMRs for hypertension-related stroke (HTN-stroke) declined from 34.28 in 2000 to 21.2 in 2019, rising to 24.44 in 2020 (AAPC: -2.3, 95% CI: -3.6 to -0.94). AAMR for HTN-stroke was higher in both genders (Males = 25.2, Females = 25.39) than AF-stroke (Males = 10.08, Females = 10.8). Non-Hispanics (NH) had a higher AAMR than Hispanics in both the categories. AAMR was the highest in HTN-stroke (NHs = 25.76, Hispanics = 10.8) and lowest in AF- stroke (NHs = 24.18, Hispanics = 6.43) Among census regions, South had the highest overall AAMR in AF-Stroke (12.3) and HTN-Stroke (28.01) while Northeast had the lowest overall AAMR in AF-Stroke (9,91) as well as HTN-Stroke (20.74). Crude mortality rates rose across all age groups, peaking in the 85+ group (AF-Stroke: 180.24, HTN-Stroke: 320.15), with most deaths in California in both groups. Mortality Rates were higher in metropolitan areas (AF-Stroke: 316,389. HTN-Stroke: 777,158) than non-metropolitan areas (AF-Stroke: 80,194, HTN-Stroke: 191,406). Conclusion Hypertension-related stroke had consistently higher mortality than atrial fibrillation-related stroke from 1999 to 2020, with both declining until 2019 and rising in 2020. Mortality was highest in the South, among those aged 85+, and in metropolitan areas. The greater burden of hypertension-related stroke underscores the need for enhanced prevention and management strategies in high-risk populations. Regional and demographic disparities highlight the importance of targeted public health interventions.

Volume

46

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