Abstract FR519: Quantifying the Stroke Burden Attributable to Elevated Systolic Blood Pressure in G20 Countries: A Longitudinal, Stratified Analysis from 1990 to 2021

Background: Stroke is a major global health threat, with high systolic blood pressure (HSBP) as its leading modifiable risk factor. G20 nations—home to over 60% of the world’s population—face a growing burden driven by demographic shifts and uneven health policies. Despite their resources, comparative assessments of HSBP-attributable stroke trends across G20 countries remain scarce. Methods: Using the GBD 2021 analytical framework, we estimated the stroke burden attributable to HSBP in G20 countries from 1990-2021, stratified by age, sex, year, and location. Age-standardized mortality rates (ASMR), disability adjusted life years (DALYs) (ASDALR), years lived with disability (YLDs) (ASYLDsR), and counts were analyzed, and temporal trends were quantified using estimated annual percentage change (APC). Result: From 1990 to 2021, stroke deaths attributable to HSBP in G20 countries rose from 2.0 million (95% UI: 1.5–2.5) to 3.0 million (2.2–3.8), DALYs increased from 46.2 million (34.7–57.3) to 64.4 million (48.1–80.0), and YLDs doubled from 3.0 million (2.0–4.1) to 6.2 million (4.1–8.5). Age-standardized rates showed modest annual percentage declines: ASMR by 0.4%, ASDALR by 0.37%, and ASYLDR by 0.04%. Nationally, South Africa recorded the highest rise in ASMR (APC: +0.54%), followed by Indonesia (+0.33%), while most countries showed a downward trend. For ASYLDR, China reported the steepest increase (APC: +1.11%), followed by Indonesia (+0.025%), whereas the U.S. experienced a notable decline (−0.55%). By age, the highest unadjusted death rate in 2021 occurred in individuals aged ≥55 years [251 (186–315) per 100,000], compared to 8.47 (5.99–10.78) in those aged 20–54. Sex-wise, males experienced a greater burden increase than females from 1990–2021: deaths rose by 65% vs 29%, DALYs by 54% vs 25%, and YLDs by 118% vs 96%. Conclusion: In 2021, G20 countries accounted for 72.41% of global stroke deaths attributable to HSBP, while within the G20, 57.84% of all stroke deaths were attributed to HSBP. Despite overall declines in age-standardized rates, the rising absolute burden of stroke attributable to HSBP—particularly among males, older adults, and emerging G20 economies—highlights the urgent need for targeted hypertension control strategies and equitable stroke prevention efforts.