Global Burden and Socioeconomic Inequalities of Hypertensive Heart Disease Among Working Age Adults From 1990 to 2021

Objective: To characterize global trends, socioeconomic inequalities, and future burden of hypertensive heart disease (HHD) among working-age adults, with a focus on the emerging shift from fatal outcomes to chronic disability.Design and method: A population-based observational study was conducted using estimates from a large global disease burden database covering 204 countries and territories from 1990 to 2021. Adults aged 20–64 years were included. Age-standardized prevalence, mortality, and disability-adjusted life year rates were calculated and analysed by age group and sex. Temporal trends were assessed over the study period. The association between socioeconomic development level and disability burden was evaluated at regional and national levels. Results: In 2021, hypertensive heart disease accounted for a substantial burden among working-age adults worldwide. Over the study period, age-standardized prevalence increased, whereas mortality and disability-adjusted life year rates declined. Burden increased markedly with age and was consistently higher in males than in females, with the greatest burden observed among adults aged 45 years and older. A strong inverse association was observed between socioeconomic development level and disability-adjusted life year rates, indicating substantially higher disability burden in less developed regions. Conclusions: Hypertensive heart disease is emerging as a major chronic condition among the global workforce. Rising prevalence combined with persistent socioeconomic inequalities is expected to sustain a substantial health and productivity burden through 2050, highlighting the need for equitable hypertension prevention and long-term management.