Documenting trends in hypertension-related Cardiovascular Disease (CVD) death rates at the county level could help motivate local efforts to prioritize hypertension prevention, detection, and control in the face of stagnant national CVD mortality rates. Bayesian spatiotemporal models were used to predict county-level hypertension-related CVD mortality rates and trends from 2000 to 2010 and 2010 to 2019 for persons aged more than or equal to 35 years overall and by age group, race or ethnicity, and sex using death certificate data from the National Vital Statistics System. Countywide hypertension-related CVD death rates increased from 23.2 per 100,000 in 2000 to 43.4 per 100,000 in 2019. County-level hypertension-related CVD death rates rose from 362.1 per 100,000 in 2000 to 430.1 per 100,000 in 2019. Adults aged 35 to 64 years experienced higher and more frequent increases than those aged more than or equal to 65 years. Between 2000 and 2010, more than 75% of counties saw an increase in hypertension-related CVD death rates among patients aged 35 to 64 years (76.2% [95% CI, 74.7–78.4] and 86.2% [95% CI, 84.6–87.6], respectively), compared to 48.2% (95% CI, 47.0–49.7) for patients aged more than or equal to 65 and 66.1% (95% CI, 64.9–67.1). Men and people of color had the most significant percentages in both age categories. In both age ranges, all racial and ethnic groupings had broad gains at the county level. Significant, widespread increases in hypertension-related CVD mortality at the county level signaled the need for increased clinical and public health efforts to enhance hypertension prevention, detection, and treatment and avoid subsequent CVD deaths in counties across the country.