Global inequalities, attributable risks, and future trends in hypertensive heart disease burden : An ecological study based on the Global Burden of Disease Study 2021, 1990–2021
- 1Department of Cardiovascular Medicine, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- 2Department of Digital Science and Intelligent Software, South China University of Technology, Guangzhou, Guangdong, China
- 3Department of Cardiovascular Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China.
Abstract
Hypertensive heart disease (HHD) is a major cardiovascular consequence of prolonged hypertension. This ecological study assessed global, regional, and national trends in HHD burden and its projected trajectories. The Global Burden of Disease Study 2021 provided estimates of Global Burden of Disease-defined HHD prevalence, deaths, disability-adjusted life-years (DALYs), and attributable risks for 204 countries and territories. Age-standardized prevalence rates (ASPRs), death rates (ASDRs), and DALY rates (ASDALYRs) were examined by sex, age, location, and Socio-demographic Index. Temporal trends, socioeconomic gradients, and frontier gaps were assessed. Autoregressive integrated moving average models generated exploratory projections from 2022 to 2031, with temporal holdout validation and sensitivity analysis. In 2021, HHD accounted for 12.51 million prevalent cases, 1.33 million deaths, and 25.46 million DALYs globally. From 1990 to 2021, ASPR increased from 125.44 to 148.32 per 100,000 population, whereas ASDR decreased from 20.92 to 16.32 and ASDALYR from 406.51 to 301.58 per 100,000 population. The burden was concentrated among older adults, shifted toward women at advanced ages, and remained higher in low- and middle-Socio-demographic Index settings. A high body-mass index was the leading selected risk factor other than high systolic blood pressure, with its DALY-attributable fraction increasing from 35.6 to 48.9%. By 2031, ASPR was projected to increase to 152.04 per 100,000 population, whereas ASDR and ASDALYR were projected to decline to 12.27 and 234.92 per 100,000 population, respectively. Validation and sensitivity analyses generally supported the qualitative consistency of these trajectories, although their magnitude varied for some series. HHD remains a growing chronic cardiovascular burden despite declining age-standardized fatal and disabling outcomes. Early hypertension detection, sustained blood pressure control, weight management, and targeted prevention in disadvantaged regions and older women are needed. The projections should be interpreted as exploratory.
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BibTeX
@article{yan2026global,
title = {{Global inequalities, attributable risks, and future trends in hypertensive heart disease burden : An ecological study based on the Global Burden of Disease Study 2021, 1990–2021}},
author = {Changshun Yan and Su Hu and Hangyu Cao and Min Gao and Rui Xu and Menghan Xu and Genshan Ma and Guiqiu Cao},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051248},
url = {https://europepmc.org/article/PMC/PMC13727210},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Global inequalities, attributable risks, and future trends in hypertensive heart disease burden : An ecological study based on the Global Burden of Disease Study 2021, 1990–2021
AU - Changshun Yan
AU - Su Hu
AU - Hangyu Cao
AU - Min Gao
AU - Rui Xu
AU - Menghan Xu
AU - Genshan Ma
AU - Guiqiu Cao
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051248
UR - https://europepmc.org/article/PMC/PMC13727210
AB - Hypertensive heart disease (HHD) is a major cardiovascular consequence of prolonged hypertension. This ecological study assessed global, regional, and national trends in HHD burden and its projected trajectories. The Global Burden of Disease Study 2021 provided estimates of Global Burden of Disease-defined HHD prevalence, deaths, disability-adjusted life-years (DALYs), and attributable risks for 204 countries and territories. Age-standardized prevalence rates (ASPRs), death rates (ASDRs), and DALY rates (ASDALYRs) were examined by sex, age, location, and Socio-demographic Index. Temporal trends, socioeconomic gradients, and frontier gaps were assessed. Autoregressive integrated moving average models generated exploratory projections from 2022 to 2031, with temporal holdout validation and sensitivity analysis. In 2021, HHD accounted for 12.51 million prevalent cases, 1.33 million deaths, and 25.46 million DALYs globally. From 1990 to 2021, ASPR increased from 125.44 to 148.32 per 100,000 population, whereas ASDR decreased from 20.92 to 16.32 and ASDALYR from 406.51 to 301.58 per 100,000 population. The burden was concentrated among older adults, shifted toward women at advanced ages, and remained higher in low- and middle-Socio-demographic Index settings. A high body-mass index was the leading selected risk factor other than high systolic blood pressure, with its DALY-attributable fraction increasing from 35.6 to 48.9%. By 2031, ASPR was projected to increase to 152.04 per 100,000 population, whereas ASDR and ASDALYR were projected to decline to 12.27 and 234.92 per 100,000 population, respectively. Validation and sensitivity analyses generally supported the qualitative consistency of these trajectories, although their magnitude varied for some series. HHD remains a growing chronic cardiovascular burden despite declining age-standardized fatal and disabling outcomes. Early hypertension detection, sustained blood pressure control, weight management, and targeted prevention in disadvantaged regions and older women are needed. The projections should be interpreted as exploratory.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -