Stroke is the second leading cause of death worldwide and disability, with hypertension being its most significant modifiable risk factor. Understanding the trends and disparities in hypertension and stroke-related mortality is crucial for effective public health intervention.

A retrospective analysis utilising data from CDC WONDER database. We examined the crude death rate and age-adjusted mortality (AAMR) rates among individuals of all ages using ICD-10 codes to evaluate temporal trends, gender and racial disparities, and geographical variations.

Overall deaths decreased by 41% from 1999 (n=91,051 deaths) to 2020 (n=53.667 deaths). A steeper decline was observed in women (47.1%) compared to men (30.7%). Temporal trends suggested an initial decline in AAMR until 2010, with a period of stability until 2015, followed by significant increase from 2015 to 2020 and a sharp spike in 2020. African American populations were identified to have highest average AAMR(29.43, 95%CI: 28.65-30.22). Geographically, highest mortality was clustered in Western and Midwestern regions of the United States.

Overall mortality from stroke and hypertension has declined over two decades, but persistent disparities exist across gender, racial and geographical fronts.