Global Burden of Hypertensive Heart Disease and Modifiable Risk Factors: A 30-Year Systematic Analysis of Prevalence, Mortality, and Disability-Adjusted Life Years (1990–2021)

Abstract

Background: Hypertensive heart disease (HHD), a leading cause of heart failure, imposes growing global health burdens with significant inequity. Using Global Burden of Disease (GBD) 2021 data, this study assesses spatiotemporal trends, risk factors, and projections across 204 countries.

Methods: We analyzed GBD 2021 estimates for HHD prevalence, deaths, and disability-adjusted life years (DALYs) from 1990-2021. Trends were evaluated using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs). Burden was projected to 2050 using Bayesian age-period-cohort modeling, stratified by age, sex, and sociodemographic index (SDI).

Results: In 2021, HHD affected 12.5 million people globally, causing 13.3 million deaths and 2.5 billion DALYs. Age-standardized death rates (ASDR) declined 0.68% annually (95% CI: −0.77 to −0.59), while age-standardized prevalence rates (ASPR) rose 0.56% yearly (95% CI: 0.52–0.60). Low SDI regions had the highest ASPR (208.4 per 100,000), especially sub-Saharan Africa. High systolic blood pressure and metabolic risks accounted for ~99% of burden in 1990 and 2021. High body mass index showed the largest risk increase since 1990 (nearly 11%), particularly in high SDI. By 2050, ASPR is projected to rise 8.5%, with men experiencing greater increases (15.7%) than women (3.6%).

Conclusions:  HHD burden remains high with stark SDI disparities. Metabolic risks increasingly surpass hypertension in high-income nations. Context-specific interventions—hypertension control in low SDI areas and metabolic risk reduction in high SDI settings—are urgently needed.