Global disparities in realized stroke prevention attributable to antihypertensive treatment: a population-level analysis of 198 countries, 1990–2019

Although antihypertensive treatment reduces stroke risk, it remains unclear whether advances in hypertension management have translated into equitable stroke prevention at the population level. We quantified realized stroke prevention attributable to antihypertensive treatment in adults aged 30-79 years across 198 countries from 1990 to 2019. In this population-level modelling analysis, we integrated country-, sex-, age-, and year-specific estimates of hypertension prevalence and treatment coverage with stroke incidence data to derive the prevented fraction for the population (PFP), defined as the proportion of strokes averted under observed treatment patterns relative to a no-treatment counterfactual. We compared PFP across sex, age, and World Bank income groups and summarized temporal trends using average annual percentage change and age-period-cohort analyses. From 1990 to 2019, median PFP increased globally from 8.8% (interquartile range, 4.9-11.1) to 15.9% (10.8-19.5) in women and from 5.1% (2.7-6.5) to 11.8% (7.7-15.3) in men, corresponding to an estimated 0.96 million model-estimated strokes averted in 2019. Although low-income countries showed the fastest annual increases, their 2019 PFP remained about half that of high-income countries. Women consistently had higher PFP than men. PFP remained low in older adults and was similarly low, or lower, in adults aged 30-34 years. These findings indicate that antihypertensive treatment has corresponded to substantial but uneven model-estimated stroke prevention worldwide, with persistent disparities by national income, sex, and age group.