NCHS Data Brief ■ No. 193 ■ March 2015

u.s. department of health and human services

centers for disease control and prevention

national center for health statistics

Hypertension-related Mortality in the United States,

2000–2013

Hsiang-Ching Kung, Ph.D., and Jiaquan Xu, M.D.

Key findings 

● The age-adjusted 

hypertension-related death 

rate increased 23.1%, whereas 

the rate for all other causes 

combined decreased 21.0% 

from 2000 through 2013.

● Rates for hypertensionrelated death increased for both 

sexes aged 45–64 and 85 and 

over from 2000 through 2013.

● The age-adjusted 

hypertension-related death 

rate increased for all Hispanic 

origin and race groups 

examined from 2000 through 

2005. Since then, the rate 

for the non-Hispanic white 

population continued to 

increase, whereas the rate 

for the non-Hispanic black 

population decreased.

● Although the age-adjusted 

hypertension-related death rate 

for the non-Hispanic black 

population was higher than 

for the non-Hispanic white 

and Hispanic populations 

throughout the period, the gap 

between them narrowed.

Hypertension is a chronic condition that can lead to heart disease, stroke, and 

other diseases that can result in premature death. Reducing the number of 

persons in the population with hypertension is one of the objectives of Healthy 

People 2020 (1). Using national multiple cause-of-death data files from the 

National Vital Statistics System, this report presents trends in hypertensionrelated mortality for 2000–2013 by selected demographic characteristics and 

the underlying causes of hypertension-related death. Hypertension-related 

mortality is defined by any mention of hypertension on the death certificate. 

Because about 2% of all decedents with hypertension reported on the death 

certificate were under age 45, only decedents aged 45 and over were included 

in this analysis.

Keywords: high blood pressure • death rate • National Vital Statistics System

The age-adjusted hypertension-related death rate increased 

23.1%, whereas the rate for all other causes of death 

combined decreased 21.0% from 2000 through 2013.

Figure 1. Number of deaths and age-adjusted death rates for hypertension-related and all other 

causes of death combined: United States, 2000–2013

1

Linear decrease from 2000 to 2013 is statistically significant at p < 0.05 level. 2

Linear increase from 2000 to 2013 is statistically significant at p < 0.05 level.

NOTES: Hypertension-related deaths are identified using ICD–10 codes I10, I11, I12, I13, and I15 for underlying and contributing 

causes of death, according to the International Classification of Diseases,10th revision (ICD–10). Rates are age-adjusted. Access 

data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db193_table.pdf#1.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

Deaths per 100,000 standard population

Number of deaths (in thousands)

0

500

1,000

1,500

2,000

2,500

0

500

1,000

1,500

2,000

2,500

3,000

2000

2001

2002

2003

2004

2005

2006

2007

Year

2008

2009

2010

2011 2013

2012

Number of all other causes of death combined

Number of hypertension-related deaths

Hypertension-related death rates2

Death rates for all other causes of death combined1
NCHS Data Brief ■ No. 193 ■ March 2015

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● The number of hypertension-related deaths increased 61.8%, from 245,220 in 2000 to 

396,675 in 2013. Overall, the number of deaths from all other causes of death combined 

increased 3.5% during the same period (Figure 1). 

● The age-adjusted hypertension-related death rate increased 23.1%, from 255.1 per 100,000 

population in 2000 to 314.1 in 2013, whereas the rate for all other causes of death combined 

decreased 21.0%, from 2,032.7 in 2000 to 1,605.9 in 2013.

● The proportion of all decedents aged 45 and over with any mention of hypertension on the 

death certificate increased steadily from 11.1% in 2000 to 16.4% in 2013.

The hypertension-related death rate was higher for women than men 

aged 85 and over but was lower for women aged 45–64, 65–74, and 75–84 

throughout the 2000–2013 period. 

● For women aged 85 and over, the hypertension-related death rate increased 23%, from 

2,003.1 per 100,000 population in 2000 to 2,464.4 in 2005, and it increased 27.5% for men, 

from 1,654.8 in 2000 to 2,110.4 in 2005 (Figure 2). The rates for both women and men 

continued to increase through 2013 but at a much slower pace.

● Among persons aged 75–84, the rate for women increased 10.9% from 2000 through 2005, 

and then changed from 692.3 in 2006 to 689.7 per 100,000 population in 2013. The rate 

increased 15.3% for men from 2000 through 2005 and continued to increase slightly, by 

6.2% by 2013.

● From 2000 through 2013, the death rate increased 16.5% for men aged 65–74. Rates 

increased 58.2% for men and 36.8% for women aged 45–64. 

Deaths per 100,000 population

Figure 2. Hypertension-related death rates, by sex and selected age group: United States, 2000–2013

NOTES: Linear increases from 2000 through 2013 for all male age groups and women aged 45–64 and 85 and over are statistically significant at the p < 0.05 

level. Hypertension-related deaths are identified using ICD–10 codes I10, I11, I12, I13, and I15, according to the International Classification of Diseases, 10th 

revision (ICD–10). Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db193_table.pdf#2. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

Men, 75–84

Women, 85 and over

Men, 85 and over

0

500

1,000

1,500

2,000

2,500

3,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year

Women, 65–74

Women, 75–84

Men, 65–74 Men, 45–64 Women, 45–64
NCHS Data Brief ■ No. 193 ■ March 2015

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From 2000 through 2013, the age-adjusted hypertension-related death rate 

was highest among the non-Hispanic black population compared with the 

non-Hispanic white and Hispanic populations. 

● From 2000 through 2013, the age-adjusted hypertension-related death rate increased for 

the non-Hispanic white population. For the non-Hispanic black and Hispanic populations, 

the rate increased from 2000 through 2005; since then, it decreased for non-Hispanic black 

persons and fluctuated for Hispanic population (Figure 3).

● For the non-Hispanic black population, the rate increased 6.8% from 523.8 per 100,000 

population in 2000 to 559.3 in 2005, and then it decreased 8.8% to 509.9 in 2013. For 

the Hispanic population, the rate increased 18.9% from 233.7 in 2000 to 277.9 in 2005, 

decreased 5.4% to 262.9 in 2009, and then increased 8.3% to 284.8 in 2013. For the nonHispanic white population, the rate increased 29.8% from 228.5 in 2000 to 296.5 in 2013.

● Although the age-adjusted hypertension-related death rate for the non-Hispanic black 

population was consistently higher than that for non-Hispanic white and Hispanic 

populations throughout the period, the gap between them narrowed.

Deaths per 100,000 standard population

Figure 3. Age-adjusted hypertension-related death rates, by race and Hispanic origin: United States, 2000–2013

NOTES: Linear increases for the non-Hispanic white population from 2000 through 2013 and for the Hispanic and non-Hispanic black populations from 2000 

through 2005 are statistically significant at the p < 0.05 level. Linear decreases for the non-Hispanic black population from 2005 to 2013 and for the Hispanic 

population from 2005 to 2009 are statistically significant at the p < 0.05 level. Hypertension-related deaths are identified using ICD–10 codes I10, I11, I12, I13, and 

I15 for underlying and contributing causes of death, according to the International Classification of Diseases, 10th revision (ICD–10). Access data table for Figure 

3 at: http://www.cdc.gov/nchs/data/databriefs/db193_table.pdf#3.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

Non-Hispanic black

Non-Hispanic white

Hispanic

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year

0

100

200

300

400

500

600
NCHS Data Brief ■ No. 193 ■ March 2015

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In 2000 and 2013, the top five underlying causes of hypertension-related 

death were heart disease, hypertension, stroke, cancer, and diabetes. 

● Hypertension was selected as the underlying cause of death in one out of six hypertensionrelated deaths in 2000 and 2013 (Figure 4). In the remaining 83%, another underlying cause 

of death was selected.

● Heart disease, stroke, cancer, and diabetes accounted for 65% of all deaths with any mention 

of hypertension in 2000, and for 54% in 2013.

● Between 2000 and 2013, the proportion of all hypertension-related deaths that had heart 

disease as the underlying cause of death decreased from 34.2% to 27.7%, and the proportion 

that had stroke as the underlying cause of death decreased from 14.9% to 9.2%.

Figure 4. Distribution of the underlying causes of hypertension-related death: United States, 2000 and 2013 Percent of total deaths

2000 2013

1

Significantly different from year 2000 at the p < 0.01 level.

NOTE: The causes were coded for Heart disease as I00–I09 and I20–I51, Hypertension as I10–I15, Cancer as C00–C97, Stroke as I60–I69, and Diabetes as

E10–E14, based on the International Classification of Diseases, 10th revision.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

34.2

17.5

14.9

9.1

7.0

17.4

1

27.7

17.5

1

9.2 1

10.1

1

7.5

1

28.1

0

5

10

15

20

25

30

35

40

Heart disease Hypertension Stroke Cancer Diabetes Other
NCHS Data Brief ■ No. 193 ■ March 2015

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Summary

This report reveals a continued rise in the hypertension-related death rate during the 2000–2013 

period, following the increase that occurred during the 1980–1998 period (2). The increasing 

trend was seen in both women and men aged 45–65 and 85 and over. The rate was the highest for 

those aged 85 and over, followed by those aged 65–84 and 45–64. 

After an upward trend from 2000 through 2005, the age-adjusted hypertension-related death rate 

decreased about 9% for the non-Hispanic black population by 2013. On the other hand, rates 

for the non-Hispanic white population increased steadily throughout the period. As a result, 

the difference in rates between the non-Hispanic white population and the non-Hispanic black 

population narrowed during the period, even though the rate among non-Hispanic black persons 

continued to be highest.

The proportion of all decedents with any mention of hypertension on the death certificate where 

the underlying causes of death were heart disease and stroke (first- and third-leading underlying 

causes of hypertension-related death) decreased 19% and 38%, respectively, between 2000 and 

2013. 

This report shows that about one out of six hypertension-related deaths had hypertension as the 

underlying cause of death, and the rest had hypertension as a contributing cause of death for other 

underlying causes. Using multiple cause-of-death data, this report provides a comprehensive 

picture of the burden of hypertension-related mortality in the United States from 2000 through 

2013.

Definitions

Cause-of-death classification: Refers to medical information—including injury diagnoses and 

external causes of injury—entered on death certificates filed in the United States that is classified 

and coded in accordance with the International Statistical Classification of Diseases and Related 

Health Problems, 10th Revision (ICD–10) (3).

Underlying cause of death: Defined by the World Health Organization as “the disease or injury 

which initiated the train of events leading directly to death, or the circumstances of the accident 

or violence which produce the fatal injury” (3). The underlying cause of death is selected from 

the condition entered by the medical certifier in the cause-of-death section of the death certificate. 

The number of deaths due to underlying causes is ranked among all hypertension-related deaths 

to select the top five causes. See the Technical Notes of “Deaths: Final Data for 2010” (4) for 

more detail.

Hypertension-related death: Defined as a death with hypertension reported (any mention of 

hypertension) on the death certificate, including essential hypertension (ICD–10 code I10), 

hypertensive heart disease (I11), hypertensive renal disease (I12), hypertensive heart and renal 

disease (I13), and secondary hypertension (I15).
NCHS Data Brief ■ No. 193 ■ March 2015

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Data sources and methods

Data presented in this report reflect information collected on death certificates filed by the 50 

states and the District of Columbia in the United States. Data are from the public-use multiple 

cause-of-death files from the National Vital Statistics System from 2000 through 2013 (5). Death 

rates are based on the enumerated population as of April 1, 2000, and April 1, 2010, intercensal 

population estimates as of July 1, 2001–2009, and postcensal population estimates as of July 

1, 2011–2013 that are consistent with the April 1, 2000, and April 1, 2010, census (6). The 

direct standardization method was used to calculate age-adjusted death rates. Rates are based 

on the projected year 2000 standard population (7). The significance of trends was tested using 

the Joinpoint regression program at α = 0.05 level (8). Differences between percentages were 

evaluated using a two-tailed z test at the 0.01 level.

About the authors

Hsiang-Ching Kung and Jiaquan Xu are with CDC’s National Center for Health Statistics, 

Division of Vital Statistics, Mortality Statistics Branch.
NCHS Data Brief ■ No. 193 ■ March 2015

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References

1. HHS. Healthy People 2020. Available from: http://www.healthypeople.gov.

2. Ayala C, Croft JB, Wattigney WA, Mensah GA. Trends in hypertension-related death in the 

United States: 1980–1998. J Clin Hypertens 6(12):675–81. 2004. Available from: 

http://onlinelibrary.wiley.com/doi/10.1111/j.1524-6175.2004.03730.x/pdf.

3. WHO. International statistical classification of diseases and related health problems, 10th 

revision (ICD–10). 2nd ed. Geneva, Switzerland. 2004.

4. Murphy SL, Xu JQ, Kochanek KD. Deaths: Final data for 2010. National vital statistics 

reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics. 2013. Available from: 

http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.

5. NCHS. Vital statistics data available online. Mortality multiple cause files. Available from: 

http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm.

6. NCHS. U.S. census populations with bridged race categories. Available from: http://www.

cdc.gov/nchs/nvss/bridged_race.htm.

7. Anderson RN, Rosenberg HM. Age standardization of death rates: Implementation of the 

year 2000 standard. National vital statistics report; vol 47 no 3. Hyattsville, MD: National Center 

for Health Statistics. 1998. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.

pdf.

8. National Cancer Institute. Joinpoint Regression Program (Version 4.1.1.) [computer 

software]. 2014.
NCHS Data Brief ■ No. 193 ■ March 2015

Suggested citation

Kung HC, Xu JQ. Hypertension-related 

mortality in the United States, 2000–2013. 

NCHS data brief, no 193. Hyattsville, MD: 

National Center for Health Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

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