National and Subnational Burden of Hypertensive Heart Disease and Its Attributable Risk Factors in Iran From 1990 to 2021: A Secondary Analysis of the Global Burden of Disease 2021 Study

ABSTRACT Background and Aims Hypertensive heart disease (HHD) impairs health and significantly increases the global cardiovascular disease burden. Despite existing global and national studies, updated subnational data on HHD burden and its risk factors in Iran using the latest GBD estimates remain limited. Our study aimed to examine the national and subnational burden of HHD and its associated risk factors in Iran from 1990 to 2021, by age, sex, and sociodemographic index (SDI). Methods Data on the prevalence, disability‐adjusted life‐years (DALYs), and deaths of HHD in Iran and its provinces from 1990 to 2021 were extracted from the Global Burden of Disease 2021 study. HHD was defined based on the International Classification of Diseases, with estimates derived from the Cause of Death Ensemble model. Age‐standardized rates and changes from 1990 to 2021, and the relationship with SDI (via smoothing splines to flexibly model nonlinear associations) were calculated. Results Age‐standardized prevalence of HHD in Iran rose 10.7% from 1990 to 2021, while DALY and death rates fell 33.6% and 30.9%, respectively. In 2021, prevalence was highest in Markazi and lowest in Tehran; East Azarbayejan had the highest DALY and death rates. High systolic blood pressure had the highest attributable burden. Prevalence was higher in men, but women had higher DALY and death rates. Burden decreased with higher SDI. Conclusion Over more than three decades, the age‐standardized DALYs and death rates for HHD decreased, whereas its prevalence rates increased. Targeted provincial and high‐risk group (elderly, women, lower‐SDI areas) prevention programs focused on blood‐pressure control are needed.