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

Abstract

Background. Few studies have assessed the association between hypertension and risk of detailed causes of death. We investigated the association between hypertension and all-cause mortality and 67 causes of death in a large cohort. Methods. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for self-reported hypertension vs. no hypertension and mortality. Adults aged ≥18 years ( $n=213798$ ) were recruited in 1997-2004 and followed through December 31, 2006. Results. During 5.81 years of follow-up, 11254 deaths occurred. Self-reported hypertension vs. no hypertension was associated with increased risk of all-cause mortality ( $\text{HR}=1.25$ , 95% CI: 1.19-1.31) and mortality from septicemia (HR =1.66, 1.06-2.59), other infectious parasitic diseases ( $\text{HR}=2.67$ , 1.09-6.51), diabetes mellitus ( $\text{HR}=1.97$ , 1.45-2.67), circulatory disease ( $\text{HR}=1.49$ , 1.37-1.61), hypertensive heart disease ( $\text{HR}=3.23$ , 2.00-5.20), ischemic heart disease $(\text{HR}=1.35$ , 1.23-1.49), acute myocardial infarction ( $\text{HR}=1.50$ , 1.27-1.77), other chronic ischemic heart diseases ( $\text{HR}=1.35$ , 1.17-1.56), all other forms of heart disease ( $\text{HR}=1.51$ , 1.21-1.89), primary hypertension and renal disease ( $\text{HR}=3.11$ , 1.82-5.30), cerebrovascular disease ( $\text{HR}=1.64$ , 1.37-1.97), other circulatory system diseases ( $\text{HR}=1.71$ , 1.09-2.69), other chronic lower respiratory diseases ( $\text{HR}=1.39$ , 1.12-1.73), other chronic liver disease ( $\text{HR}=1.89$ , 1.06-3.37), renal failure ( $\text{HR}=1.91$ , 1.33-2.74), motor vehicle accidents ( $\text{HR}=1.60$ , 1.07-2.37), and all other diseases (HR =1.30, 1.10-1.54), but with lower risk of uterine cancer ( $\text{HR}=0.37$ , 95% CI: 0.15-0.90) and Alzheimer’s disease ( $\text{HR}=0.65$ , 95% CI: 0.47-0.92). Conclusion. Hypertension was associated with increased risk of all-cause mortality and 17 out of 67 causes of death, with most of these being circulatory disease outcomes, however, some of the remaining associations are unlikely to be causal. Further studies are needed to clarify associations with less common causes of death and potential causality across outcomes.