{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:27:21Z","timestamp":1788564441544,"version":"build-2803163510"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institutes of Health, Department of Health and Human Service","award":["R01 HL80477"],"award-info":[{"award-number":["R01 HL80477"]}]},{"name":"National Institutes of Health, Department of Health and Human Service","award":["R01 HL165452"],"award-info":[{"award-number":["R01 HL165452"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>A substantial proportion of adults with hypertension die from causes other than cardiovascular disease (CVD), but the frequencies are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We calculated the frequency of causes of death for adults with and without hypertension using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which enrolled non-Hispanic Black and White adults aged\u2005\u2265\u200545 years in 2003\u20132007. Participants were followed until death or 31 December 2019. Blood pressure (BP) was measured at baseline and at a follow-up examination in 2013\u20132016. Hypertension was defined as systolic BP\u2005\u2265\u2005130 mmHg or diastolic BP\u2005\u2265\u200580 mmHg, or self-reported antihypertensive medication use, and modeled a time-varying exposure. The outcome was the adjudicated underlying cause of death, determined from all available information, including death certificates, medical records, autopsy reports, and interviews with proxies or next of kin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 8,933 deaths among 23,622 participants with hypertension and 1,709 deaths among 5,744 participants without hypertension over a median 8.1 years of follow-up. Among participants who died, the most common causes of death were CVD (31.2%), cancer (22.1%), and infection (11.6%) among participants with hypertension and cancer (29.8%), CVD (23.2%), and dementia (11.8%) among participants without hypertension. Among participants with and without hypertension, the 10-year cumulative incidence was 8.2% and 3.6% for CVD mortality, respectively, 5.8% and 4.9% for cancer mortality, and 2.8% and 1.5% for infection mortality, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Among adults with hypertension, a majority of deaths were from non-CVD causes, including one-third of deaths from cancer and infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf115","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T07:52:21Z","timestamp":1750924341000},"page":"1096-1105","source":"Crossref","is-referenced-by-count":2,"title":["Leading Causes of Death Among US Adults With and Without Hypertension: Data From the REGARDS Study"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6380-2735","authenticated-orcid":false,"given":"Kathryn","family":"Foti","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisandro D","family":"Colantonio","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy B","family":"Plante","sequence":"additional","affiliation":[{"name":"Department of Medicine, Larner College of Medicine at the University of Vermont , Burlington, Vermont ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9930-3575","authenticated-orcid":false,"given":"Lama","family":"Ghazi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakia T","family":"Hardy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily B","family":"Levitan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika M","family":"Safford","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Muntner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham School of Public Health , Birmingham, Alabama ,","place":["USA"]},{"name":"Perisphere Real World Evidence, LLC , Austin, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"2025112010052634400_CIT0001","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1093\/ajh\/hpae141","article-title":"Trends in blood pressure control among US adults with hypertension, 2013\u20132014 to 2021\u20132023","volume":"38","author":"Hardy","year":"2025","journal-title":"Am J Hypertens"},{"key":"2025112010052634400_CIT0002","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1161\/HYPERTENSIONAHA.119.14240","article-title":"High blood pressure and cardiovascular disease","volume":"75","author":"Fuchs","year":"2020","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0003","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1161\/HYPERTENSIONAHA.123.22220","article-title":"Trends in all-cause, cardiovascular, and noncardiovascular mortality among US adults with hypertension","volume":"81","author":"Choi","year":"2024","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0004","doi-asserted-by":"publisher","first-page":"e004966","DOI":"10.1161\/JAHA.116.004966","article-title":"Comparison of expert adjudicated coronary heart disease and cardiovascular disease mortality with the national death index: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study","volume":"6","author":"Olubowale","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025112010052634400_CIT0005","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:122516","volume-title":"Mortality in the United States, 2021","author":"Xu","year":"2022"},{"key":"2025112010052634400_CIT0006","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.medj.2020.11.001","article-title":"Elevated blood pressure increases pneumonia risk: epidemiological association and mendelian randomization in the UK biobank","volume":"2","author":"Zekavat","year":"2021","journal-title":"Med (New York, N.Y.)"},{"key":"2025112010052634400_CIT0007","doi-asserted-by":"publisher","first-page":"e021715","DOI":"10.1161\/JAHA.121.021715","article-title":"Flu vaccine and mortality in hypertension: a nationwide cohort study","volume":"11","author":"Modin","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2025112010052634400_CIT0008","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1161\/CIRCULATIONAHA.122.061183","article-title":"Severe infection and risk of cardiovascular disease: a multicohort study","volume":"0","author":"Sipil\u00e4","year":"2023","journal-title":"Circulation"},{"key":"2025112010052634400_CIT0009","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/ajh\/hpae040","article-title":"Trends in the prevalence of multiple chronic conditions among US adults with hypertension from 1999\u20132000 through 2017\u20132020","volume":"37","author":"Alanaeme","year":"2024","journal-title":"Am J Hypertens"},{"key":"2025112010052634400_CIT0010","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1093\/ajh\/hpae108","article-title":"Assessing the accuracy of reporting of hypertension on death certificates in Australia","volume":"37","author":"Adair","year":"2024","journal-title":"Am J Hypertens"},{"key":"2025112010052634400_CIT0011","doi-asserted-by":"publisher","first-page":"9376134","DOI":"10.1155\/2021\/9376134","article-title":"Hypertension and the risk of all-cause and cause-specific mortality: an outcome-wide association study of 67 causes of death in the national health interview survey","volume":"2021","author":"Aune","year":"2021","journal-title":"Biomed Res Int"},{"key":"2025112010052634400_CIT0012","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1159\/000086678","article-title":"The reasons for geographic and racial differences in stroke study: objectives and design","volume":"25","author":"Howard","year":"2005","journal-title":"Neuroepidemiology"},{"key":"2025112010052634400_CIT0013","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/jgs.14472","article-title":"Racial differences in the incidence of cardiovascular risk factors in older black and white adults","volume":"65","author":"Howard","year":"2017","journal-title":"J Am Geriatr Soc"},{"key":"2025112010052634400_CIT0014","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jash.2010.02.001","article-title":"Prevalence of hypertension by duration and age at exposure to the stroke belt","volume":"4","author":"Howard","year":"2010","journal-title":"J Am Soc Hypertens"},{"key":"2025112010052634400_CIT0015","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1161\/HYP.0000000000000065","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0016","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1093\/aje\/kwr033","article-title":"Agreement on cause of death between proxies, death certificates, and clinician adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study","volume":"173","author":"Halanych","year":"2011","journal-title":"Am J Epidemiol"},{"key":"2025112010052634400_CIT0017","doi-asserted-by":"publisher","first-page":"696","DOI":"10.2105\/AJPH.2019.305543","article-title":"Black\u2013white differences in cardiovascular disease mortality: a prospective US study, 2003\u20132017","volume":"110","author":"Tajeu","year":"2020","journal-title":"Am J Public Health"},{"key":"2025112010052634400_CIT0018","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/epirev\/mxad010","article-title":"\u201cWe adjusted for race\u201d now what: a systematic review of utilization and reporting of race in AJE and epidemiology, 2020\u20132021","volume":"45","author":"Swilley-Martinez","year":"2023","journal-title":"Epidemiol Rev"},{"key":"2025112010052634400_CIT0019","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1161\/HYPERTENSIONAHA.120.15196","article-title":"Multiple social vulnerabilities to health disparities and hypertension and death in the REGARDS study","volume":"79","author":"King","year":"2022","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0020","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1353\/hpu.2011.0127","article-title":"Health professional shortage areas, insurance status, and cardiovascular disease prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study","volume":"22","author":"Brown","year":"2011","journal-title":"J Health Care Poor Underserved"},{"key":"2025112010052634400_CIT0021","author":"United Health Foundation"},{"key":"2025112010052634400_CIT0022","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1161\/HYPERTENSIONAHA.122.20219","article-title":"Social determinants of health and uncontrolled blood pressure in a national cohort of black and white US adults: the REGARDS study","volume":"80","author":"Akinyelure","year":"2023","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0023","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C\u2013based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"2025112010052634400_CIT0024","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation"},{"key":"2025112010052634400_CIT0025","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1097\/EDE.0b013e3181a819a1","article-title":"Overadjustment bias and unnecessary adjustment in epidemiologic studies","volume":"20","author":"Schisterman","year":"2009","journal-title":"Epidemiology"},{"key":"2025112010052634400_CIT0026","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.1001\/jama.289.19.2560","article-title":"The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report","volume":"289","author":"Chobanian","year":"2003","journal-title":"JAMA"},{"key":"2025112010052634400_CIT0027","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.1161\/CIR.0000000000001209","article-title":"2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association","volume":"149","author":"Martin","year":"2024","journal-title":"Circulation"},{"key":"2025112010052634400_CIT0028","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis","volume":"387","author":"Ettehad","year":"2016","journal-title":"Lancet (London, England)"},{"key":"2025112010052634400_CIT0029","volume-title":"The Surgeon General\u2019s Call to Action to Control Hypertension.","author":"US Department of Health and Human Services","year":"2020"},{"key":"2025112010052634400_CIT0030","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1161\/HYPERTENSIONAHA.122.20292","article-title":"Effectiveness and cost-effectiveness of team-based care for hypertension: a meta-analysis and simulation study","volume":"80","author":"Bryant","year":"2023","journal-title":"Hypertension"},{"key":"2025112010052634400_CIT0031","doi-asserted-by":"publisher","first-page":"e005624","DOI":"10.1161\/CIRCOUTCOMES.118.005624","article-title":"Clinic-based strategies to reach United States million hearts 2022 blood pressure control goals","volume":"12","author":"Bellows","year":"2019","journal-title":"Cir Cardiovasc Qual Outcomes"},{"key":"2025112010052634400_CIT0032","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1016\/S0140-6736(21)00590-0","article-title":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis","volume":"397","author":"Rahimi","year":"2021","journal-title":"Lancet"},{"key":"2025112010052634400_CIT0033","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1001\/jamacardio.2020.1731","article-title":"Association of normal systolic blood pressure level with cardiovascular disease in the absence of risk factors","volume":"5","author":"Whelton","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2025112010052634400_CIT0034","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1001\/jamacardio.2023.3241","article-title":"Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999-2020","volume":"8","author":"Ostrominski","year":"2023","journal-title":"JAMA Cardiol"},{"key":"2025112010052634400_CIT0035","doi-asserted-by":"publisher","first-page":"2059","DOI":"10.1111\/jgs.16558","article-title":"Association of sustained blood pressure control with multimorbidity progression among older adults","volume":"68","author":"Bowling","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"2025112010052634400_CIT0036","author":"United States Preventive Services Task Force"},{"key":"2025112010052634400_CIT0037","author":"Centers for Disease Control and Prevention","journal-title":"Adult Immunization Schedule"},{"key":"2025112010052634400_CIT0038","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1377\/hlthaff.2017.1248","article-title":"Few Americans receive all high-priority, appropriate clinical preventive services","volume":"37","author":"Borsky","year":"2018","journal-title":"Health Aff (Project Hope)"},{"key":"2025112010052634400_CIT0039","doi-asserted-by":"publisher","first-page":"S52","DOI":"10.2337\/dc24-S004","article-title":"4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes\u20142024","volume":"47","author":"American Diabetes Association Professional Practice Committee","year":"2023","journal-title":"Diabetes Care"},{"key":"2025112010052634400_CIT0040","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1186\/s12913-023-09894-7","article-title":"Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review","volume":"23","author":"Rohwer","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2025112010052634400_CIT0041","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1186\/s13643-021-01817-z","article-title":"Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review","volume":"10","author":"Smith","year":"2021","journal-title":"Syst Rev"},{"key":"2025112010052634400_CIT0042","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s11906-017-0724-3","article-title":"Defining the relationship between hypertension, cognitive decline, and dementia: a review","volume":"19","author":"Walker","year":"2017","journal-title":"Curr Hypertens Rep"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/advance-article-pdf\/doi\/10.1093\/ajh\/hpaf115\/63615885\/hpaf115.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/38\/12\/1096\/63615885\/hpaf115.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/38\/12\/1096\/63615885\/hpaf115.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T15:05:39Z","timestamp":1763651139000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/38\/12\/1096\/8177133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,28]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6,28]]},"published-print":{"date-parts":[[2025,11,17]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpaf115","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,6,28]]}}}