{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:17:46Z","timestamp":1787804266744,"version":"build-2784847793"},"reference-count":94,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hypertension, affecting nearly half of US adults, is a significant modifiable risk factor for Alzheimer's disease (AD), the fifth leading cause of death among Americans aged 65 and older. Hypertension contributes to AD through microvascular damage, reduced cerebral perfusion and neuroinflammation, leading to cognitive decline and dementia.\u00a0This study examines US national trends and disparities in mortality due to comorbid AD and hypertension in older adults (\u226565 years) using CDC WONDER data from 1999\u20132019. Age\u2010adjusted mortality rates (AAMRs) per 100\u00a0000 individuals and crude rates (CRs) were determined. Joinpoint regression was used to calculate Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs).\u00a0A total of 372\u00a0839 deaths occurred, increasing from 4948 to 27\u00a0257 annually (1999\u20132019). AAMRs rose from 14.51 to 53.13, with an AAPC of 6.16%. Females (47.09) had higher AAMRs than males (33.80). Non\u2010Hispanic Blacks experienced the highest mortality rates (54.82), while NH Asians had the lowest (28.14); Hispanics experienced the highest AAPC (6.81). The 85+ age group bore the greatest mortality burden (AAPC: 6.84%). Most deaths (60.05%) occurred in hospice\/nursing facilities. Mortality was highest in the West (AAMR: 50.28) and lowest in the Northeast (27.00). Mississippi had the highest, Massachusetts the lowest state\u2010level mortality burden. Non\u2010metropolitan areas exceeded metropolitan AAMRs (47.89 vs. 41.28).\u00a0Targeted interventions are needed to counter observed trends, addressing hypertension as a key manageable risk factor for AD prevention.<\/jats:p>","DOI":"10.1111\/jch.70348","type":"journal-article","created":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T02:46:02Z","timestamp":1786848362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rising Comorbid Alzheimer's and Hypertension Mortality in Older Adults in the United States: Trends and Disparities From a 21\u2010Year CDC WONDER Analysis (1999\u20132019)"],"prefix":"10.1111","volume":"28","author":[{"given":"Manal","family":"Kaleem","sequence":"first","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of Medicine Services Institute of Medical Sciences  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. N. U.","family":"Kalpina","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoor","family":"Fatima","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syeda Javaria","family":"Batool","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bareeha","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamda","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musaba","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4261-0638","authenticated-orcid":false,"given":"Mustafa","family":"Turkmani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toledo  Toledo Ohio USA"},{"name":"Faculty of Medicine Michigan State University, East Lansing  Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ubaid","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","unstructured":"2023 Alzheimer's Disease Facts and Figures. Alzheimer's & Dementia: The Journal of the Alzheimer's Association2023;19(4):1598\u20131695.","DOI":"10.1002\/alz.13016"},{"key":"e_1_2_10_3_1","unstructured":"Alzheimer's Disease in the US \u2010 2025 Facts and Figures. North American Community Hub Statistics (2025).https:\/\/nchstats.com\/alzheimers\u2010disease\u2010in\u2010the\u2010us\/."},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","unstructured":"2024 Alzheimer's Disease Facts and Figures. Alzheimer\u2018s & Dementia: The Journal of the Alzheimer\u2019s Association2024;20(5):3708\u20133821.","DOI":"10.1002\/alz.13809"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00340-9"},{"issue":"8","key":"e_1_2_10_6_1","first-page":"1","article-title":"Deaths: Final Data for 2021","volume":"73","author":"Murphy S. L.","year":"2024","journal-title":"National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System"},{"issue":"4","key":"e_1_2_10_7_1","article-title":"Risk Factors Associated With Hypertension in Young Adults: A Systematic Review","volume":"15","author":"Meher M.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.309115"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2022.937486"},{"issue":"511","key":"e_1_2_10_10_1","article-title":"Hypertension Prevalence, Awareness, Treatment, and Control among Adults Age 18 and Older: United States, August 2021\u2010August 2023","author":"Fryar C. D.","year":"2024","journal-title":"NCHS Data Brief"},{"key":"e_1_2_10_11_1","unstructured":"Hypertension. (World Health Organization 2025).https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/hypertension."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2023.61"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-190474"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.33353"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30367-6"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1282131"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.07.008"},{"key":"e_1_2_10_18_1","unstructured":"Multiple Cause of Death 1999 \u2010 2020. (2025).https:\/\/wonder.cdc.gov\/wonder\/help\/mcd.html."},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_10_20_1","unstructured":"2013 NCHS Urban\u2013Rural Classification Scheme for Counties. (2023).https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02_166.pdf."},{"issue":"3","key":"e_1_2_10_21_1","first-page":"1","article-title":"Age Standardization of Death Rates: Implementation of the Year 2000 Standard","volume":"47","author":"Anderson R. N.","year":"1998","journal-title":"National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System"},{"key":"e_1_2_10_22_1","unstructured":"Joinpoint Regression Program. (2025).https:\/\/surveillance.cancer.gov\/joinpoint\/."},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.14283\/jpad.2022.73"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/procel\/pwae026"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.00005"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.122.18085"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-021-00430-6"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2011.06.020"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2016.03.012"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32836184b5"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.0244"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2018.11.001"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30412-9"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac354"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2023.1267434"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000133128.42462.ef"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2024.1448034"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.02.016"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12526"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.15085643"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70235"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.4061\/2010\/606802"},{"issue":"12","key":"e_1_2_10_44_1","article-title":"The Latest Advances in the Diagnosis and Treatment of Dementia","volume":"15","author":"Hafiz R.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD\u2010160470"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.100927"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21442"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.10551"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD\u20102010\u2010091552"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.8164"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.17283"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(21)00283-X"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-210252"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13452"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756286420985237"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2015.01.027"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.5306"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224975"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24135"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-23353-z"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.110.152892"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-024-02115-5"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.14836"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13627"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206705"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.13.1595"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2020.01.014"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L368"},{"key":"e_1_2_10_70_1","unstructured":"Data Shows Racial Disparities in Alzheimer's Disease Diagnosis Between Black and White Research Study Participants. (2021). National Institute on Aging.https:\/\/www.nia.nih.gov\/news\/data\u2010shows\u2010racial\u2010disparities\u2010alzheimers\u2010disease\u2010diagnosis\u2010between\u2010black\u2010and\u2010white\u2010research."},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-022-01826-x"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70095"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.3390\/diseases11040179"},{"issue":"10","key":"e_1_2_10_74_1","article-title":"Trends and Patterns in Hypertension\u2010Related Deaths: A Comprehensive Analysis Using Center for Disease Control and Prevention's Wide\u2010Ranging Online Data for Epidemiologic Research (CDC WONDER) Data","volume":"16","author":"Fasehun O. O.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13081"},{"key":"e_1_2_10_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17215"},{"key":"e_1_2_10_77_1","unstructured":"Health in North Dakota. USAFacts. (2023).https:\/\/usafacts.org\/topics\/health\/state\/north\u2010dakota\/."},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12335"},{"key":"e_1_2_10_79_1","unstructured":"Cardiovascular Disease Mortality. New York State Department of Health. (2011).https:\/\/www.health.ny.gov\/diseases\/cardiovascular\/heart_disease\/docs\/cvd_mortality.pdf."},{"key":"e_1_2_10_80_1","unstructured":"Massachusetts General Hospital\u2014Senior HealthWISE Program. American Hospital Association. (2012).https:\/\/www.aha.org\/case\u2010studies\/2012\u201002\u201028\u2010massachusetts\u2010general\u2010hospital\u2010senior\u2010healthwise\u2010program."},{"key":"e_1_2_10_81_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6918a1"},{"key":"e_1_2_10_82_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2020.00231"},{"key":"e_1_2_10_83_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12285"},{"key":"e_1_2_10_84_1","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.70047"},{"key":"e_1_2_10_85_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep32222"},{"key":"e_1_2_10_86_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyae027"},{"key":"e_1_2_10_87_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70125"},{"key":"e_1_2_10_88_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000053"},{"key":"e_1_2_10_89_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-200245"},{"key":"e_1_2_10_90_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.24079"},{"key":"e_1_2_10_91_1","unstructured":"Dementia Statistics. Alzheimer's Disease International. (2025).https:\/\/www.alzint.org\/about\/dementia\u2010facts\u2010figures\/dementia\u2010statistics\/."},{"key":"e_1_2_10_92_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13104"},{"key":"e_1_2_10_93_1","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241295305"},{"key":"e_1_2_10_94_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-131622"},{"key":"e_1_2_10_95_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-025-08152-4"}],"container-title":["The Journal of Clinical Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jch.70348","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jch.70348","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jch.70348","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:19:56Z","timestamp":1787800796000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jch.70348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":94,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/jch.70348"],"URL":"https:\/\/doi.org\/10.1111\/jch.70348","archive":["Portico"],"relation":{},"ISSN":["1524-6175","1751-7176"],"issn-type":[{"value":"1524-6175","type":"print"},{"value":"1751-7176","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2025-11-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70348"}}