Research Highlights:
- An analysis of 25 years of the CDC WONDER database for death rates from hypertension-related kidney disease (also called hypertensive kidney disease or hypertensive renal disease) in the U.S. through 2023 found persistent differences across race, ethnicity, gender and region.
- The highest death rates for hypertensive kidney disease were among Black individuals, followed by Hispanic individuals.
- More men died from hypertensive kidney disease than women, and states in the South had the highest death rates from hypertensive kidney disease.
- These findings highlight the urgent need for improved screening and management of high blood pressure to reduce the risk of hypertensive kidney disease, especially in communities at higher risk.
- Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
Embargoed until 5:30 p.m. ET/4:30 p.m. CT, Thursday, Sept. 4, 2025
BALTIMORE, Sept. 4, 2025 — The death rate from hypertensive kidney disease (high blood pressure-related kidney disease) increased by 48% in the U.S. over the past 25 years, with continued differences across demographic groups, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The meeting is in Baltimore, September 4-7, 2025, and is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and its relationship to cardiac and kidney disease, stroke, obesity and genetics.
“This is the first study to examine 25 years of national data on hypertensive kidney disease deaths across all U.S. states and major demographic groups,” said Joiven Nyongbella, M.D., an M.P.H. candidate and internal medicine resident at Wayne State University/Henry Ford Rochester Hospital in Detroit. “Despite national efforts to reduce health inequalities, Black individuals still had over three times the death rate compared to other groups of people.”
High blood pressure (when the force of the blood pushing against the walls of vessels is too high) is a known risk factor for kidney damage. It is the second leading cause of end-stage kidney disease and contributes significantly to morbidity and mortality. Untreated high blood pressure can lead to serious outcomes, such as heart attack, stroke, heart failure and progression to kidney failure. Globally, the rate of death from chronic kidney disease increased 24% from 1990 to 2021, according to the American Heart Association’s 2025 Heart Disease and Stroke Statistics.
This study, looking at data from 1999 – 2023, found age-adjusted mortality rate (AAMR) for hypertensive kidney disease deaths increased 48%. Men, people living in the South and Black or Hispanic adults had higher than average death rates.
“High blood pressure isn’t just about strokes or heart attacks - it’s also a major cause of kidney disease and death, especially in Black and Hispanic communities,” said Nyongbella. “The message is simple: check your blood pressure, treat it early and don’t ignore it, because it can quietly lead to life-threatening kidney problems.”
In this study, researchers reviewed data from the U.S. Centers for Disease Control and Prevention’s (CDC’s) WONDER database from 1999 to 2023 for all death certificates noted with hypertensive renal disease as the cause of death. The analysis found:
- Kidney disease caused by high blood pressure resulted in 274,667 deaths from 1999-2023 among individuals ages 15 and older.
- From 1999-2023, the age-adjusted mortality rate (AAMR) for hypertensive kidney disease deaths rose from 3.3 per 100,000 people in 1999 to 4.91 per 100,000 people in 2023, an increase of 48%.
- Men had a higher average AAMR than women (4.48 vs. 3.69, respectively), with a 22% higher mortality in individuals with renal failure.
- The highest average AAMR was for individuals who were identified as Black, at 10.37 per 100,000 people versus the range of 3.33 - 3.90 per 100,000 for people in other population groups. Hispanic individuals had a 15% higher AAMR when compared to non-Hispanic individuals (4.55 vs. 3.97, respectively).
- Across the U.S., the West had the highest overall AAMR for hypertensive kidney disease deaths at 4.59 per 100,000. In the South, Washington, D.C., (7.6 per 100,000), Tennessee (5.9) and Mississippi (5.83) had the highest AAMRs.
“This study provides important observational data indicating a concerning rise (48%) in age-adjusted deaths due to high blood pressure-related kidney disease over the last 25 years, especially among men, and Black and Hispanic individuals,” said American Heart Association volunteer expert Sidney C. Smith Jr., M.D., FAHA. “These findings are in line with the recently released 2025 AHA/ACC High Blood Pressure Guideline and AHA’s Presidential Advisory on Cardiovascular Kidney Metabolic (CKM) Health. Both papers emphasize the importance of early treatment for high blood pressure, its direct link to kidney disease, as well as the impact of social factors among high-risk populations.” Smith is a cardiologist and professor of medicine at the University of North Carolina’s School of Medicine, a past president of the American Heart Association and a co-author of the 2025 AHA/ACC High Blood Pressure Guideline; he was not involved in this study.
There are several limitations to the study’s findings. Of note, the study relied solely on death certificate data, which may include errors due to missing or mislabeled causes of death. In addition, individual health factors like access to care, medication use or diet were not available, so future research is needed to investigate these factors in addition to health data.
Study details, background and design:
- Data from the CDC WONDER database was reviewed for all death certificates in the U.S. from 1999 to 2023 with any of the ICD-10 codes for hypertensive renal disease with and without renal failure listed as a cause of death.
- The analysis included demographic information about people who had died with and without hypertensive renal disease, ages 15 to 85 and older; 54.9% were women, 23.5% were Black, 8.47% were Hispanic and 68% were from other racial and ethnic groups.
- Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by year, sex, race, ethnicity, state and region.
- The abstract also details the additional calculations used to assess trends including average annual percent change (AAPC) in deaths statistical testing.
Note: Poster Presentation #FR524 will be presented during Poster Session 2, 9:00 a.m. – 10:30 a.m. ET, Friday, Sept. 5, 2025.
Co-authors, their disclosures and funding sources are listed in the abstract.
Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.
Additional Resources:
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Research Highlights:
- Despite their effectiveness in lowering sodium intake and managing blood pressure, salt substitutes were rarely used by people with high blood pressure, according to a review of almost 20 years of U.S. health survey data.
- Researchers recommend increasing awareness of salt substitutes as a strategy to help effectively treat blood pressure, especially for individuals with difficult-to-treat or treatment-resistant high blood pressure.
- Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
Embargoed until 5:30 p.m. ET/4:30 p.m. CT, Thursday, Sept. 4, 2025
BALTIMORE, Sept. 4, 2025 — Few people with high blood pressure were using salt substitutes, even though they are a simple and effective way to lower sodium intake and manage blood pressure, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The meeting is in Baltimore, September 4-7, 2025, and is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and its relationship to cardiac and kidney disease, stroke, obesity and genetics.
High blood pressure occurs when the force of blood flowing through the blood vessels is consistently too high. High blood pressure can lead to other serious events such as heart attack and stroke. Using data from 2017 to 2020, 122.4 million (46.7%) adults in the U.S. had high blood pressure and it contributed to more than 130,000 deaths. Too much sodium and too little potassium in the diet are risk factors for high blood pressure.
“Overall, less than 6% of all U.S. adults use salt substitutes, even though they are inexpensive and can be an effective strategy to help people control blood pressure, especially people with difficult-to-treat high blood pressure,” said lead study author Yinying Wei, M.C.N., R.D.N., L.D., and Ph.D. candidate in the departments of applied clinical research and hypertension section, cardiology division, at UT Southwestern Medical Center in Dallas. “Health care professionals can raise awareness about the safe use of salt substitutes by having conversations with their patients who have persistent or hard-to-manage high blood pressure.”
Salt substitutes are products that replace some or all of the sodium with potassium. Potassium salt tastes similar to regular salt, except when heated it can have a bitter aftertaste. Many foods contain some sodium in their natural state, however, the largest amount of sodium comes from processed and packaged foods and meals prepared at restaurants. The American Heart Association recommends consuming no more than 2,300 mg of sodium a day, with an ideal limit of less than 1,500 mg per day for most adults, especially for those with high blood pressure. For most people, cutting back by 1,000 mg a day can improve blood pressure and heart health.
This study is the first to examine long-term trends in salt substitute use among a nationally representative sample of U.S. adults. Using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020, researchers analyzed the use of products that replace salt with potassium-enriched or other alternative salts.
The investigation focused on people with high blood pressure, and an additional analysis was conducted among adults eligible to use salt substitutes, including people with normal kidney function and those not taking medications or supplements that affect blood potassium levels. Some salt substitutes contain potassium, and they can raise blood potassium to dangerous levels in people with kidney disease or those taking certain medications or potassium supplements. Excessive potassium can lead to irregular heart rhythms. People with high blood pressure who are thinking about switching from regular salt to a salt substitute should first consult with a health care professional.
The analysis found:
- Overall, salt substitute use among all U.S. adults remained low, peaking at 5.4% in 2013–2014 before falling to 2.5% by 2017–March 2020. Data collection for 2020 stopped before March because of the pandemic.
- Among adults eligible to use salt substitutes, only 2.3% to 5.1% did so.
- Usage was highest in people with high blood pressure whose BP was controlled with medications (3.6%–10.5%), followed by those with high blood pressure whose BP was not controlled despite medications (3.7%–7.4%).
- Salt substitute use remained consistently less than 5.6% among people with untreated high blood pressure and for people with normal blood pressure.
- Adults who ate at restaurants three or more times a week appeared less likely to use salt substitutes compared to those who ate out less often, but this difference was no longer statistically significant after accounting for age, race/ethnicity, education level and insurance status.
“Salt substitute use remained uncommon over the last two decades including among people with high blood pressure,” Wei said. “Even among individuals with treated and poorly managed or untreated high blood pressure, most continued to use regular salt.”
“This study highlights an important and easy missed opportunity to improve blood pressure in the U.S.—the use of salt substitutes,” said Amit Khera, M.D., M.Sc., FAHA, an American Heart Association volunteer expert. “The fact that use of salt substitutes remains so low and has not improved in two decades is eye-opening and reminds patients and health care professionals to discuss the use of these substitutes, particularly in visits focused on high blood pressure.” Khera, who was not involved in this study, is a professor of medicine, clinical chief of cardiology and director of preventive cardiology at UT Southwestern Medical Center in Dallas.
The study has several limitations. First, information about salt substitute use was self-reported, so there may have been underreporting or misclassification. In addition, all types of salt substitutes were included in the analysis, therefore, the analysis could not specifically separate potassium-enriched salt from other types of salt substitutes. Finally, the survey data did not capture how much salt substitute the participants used.
“Future research should explore why salt substitute-use remains low by investigating potential barriers, such as taste acceptance, cost and limited awareness among both patients and clinicians,” said Wei. “These insights may help guide more targeted interventions.”
Study details, background and design:
- The analysis included 37,080 adults, ages 18 and older (37.9% were aged 18–39, 36.9% were aged 40–59 years, and 25.2% were aged 60 and older). 50.6% of participants were women, 10.7% of participants self-reported their race as non-Hispanic Black, and 89.3% self-reported they were from other racial and ethnic groups.
- Participants were categorized into four subgroups based on presence or absence of high blood pressure (≥130/80 mm Hg) and whether they were using blood pressure lowering medication: 1) high blood pressure that was treated and controlled; 2) high blood pressure that was treated and not controlled; 3) untreated high blood pressure; and 4) those with normal blood pressure.
- Salt types were classified as ordinary salt (iodized salt, sea salt, kosher salt), salt substitute (potassium-enriched or other salt substitute) and no salt use.
- An additional analysis was conducted on a subgroup of individuals eligible to use salt substitutes—those with healthy kidney function (estimated glomerular filtration rate ≥ 60) and not taking medications or supplements that affect blood potassium levels.
- The frequency of eating at restaurants to assess its influence on salt substitute use was also evaluated.
- All analyses incorporated NHANES sampling weights and complex survey design.
Note: Poster Presentation #TAC228 will be presented during Poster Session 1, 5:30 p.m. - 7:00 p.m. ET, Thursday, Sept. 4, 2025.
Co-authors, their disclosures and funding sources are listed in the abstract. The study is supported by a grant from the National Institutes of Health.
Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.
Additional Resources:
###
The American Heart Association’s Hypertension Scientific Sessions 2025 is a premier scientific conference dedicated to recent advancements in both basic and clinical research related to high blood pressure and its connections to cardiac and kidney diseases, stroke, obesity and genetics. The primary aim of the meeting is to bring together interdisciplinary researchers from around the globe and facilitate engagement with leading experts in the field of hypertension. Attendees will have the opportunity to discover the latest research findings and build lasting relationships with researchers and clinicians across various disciplines and career stages. Follow the conference on X using the hashtag #Hypertension25.
About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.
