Global, regional, and national burden of hypertensive heart disease in 1990–2021, with forecasts to 2050: a Global Burden of Disease Study 2021

Background: Despite its substantial burden, hypertensive heart disease (HHD) remains underrecognized. We aimed to investigate the global burden of HHD projected up to 2050. Methods: We utilized data from the Global Burden of Disease Study (GBD) 2021 to estimate the global HHD burden. The burden was assessed using prevalence, death, and disability-adjusted life years (DALYs), stratified by region, age, sex, and Socio-demographic Index (SDI), with all estimates accompanied by 95% uncertainty intervals (UIs). We ranked age-standardized DALY rates attributable to six risk factors. Forecasting analysis was conducted using the GBD 2021 forecast framework, supplemented by Das Gupta decomposition analysis. Results: From 1990 to 2021, the global age-standardized prevalence rate increased from 125.44 per 100,000 population (95% UI, 98.97-157.96) to 148.32 (117.32-186.28). In contrast, age-standardized mortality and DALY rates declined to 16.31 per 100,000 population (95% UI, 13.76-18.01) and 301.58 (255.06-332.06), respectively. HHD burden increased with age and was more pronounced in women, particularly among older populations. High systolic blood pressure ranked first among six identified risk factors. Forecasting up to 2050 projected increases in age-standardized mortality (19.11 [95% UI, 13.24-27.45]) and DALY rates (367.80 [255.27-524.52]), despite declining trends over the past three decades. Population growth was the main driver of the projected increase, as shown by Das Gupta decomposition. Conclusions: The rising burden of HHD calls for a shift away from traditional, fragmented approaches focused solely on blood pressure control. Integrated clinical and policy responses are urgently needed to address the complex and multifactorial nature of the disease.