Trends in the burden and determinants of hypertensive heart disease in the Eastern Mediterranean region, 1990-2019: an analysis of the Global Burden of Disease Study 2019

Abstract

Background: Hypertensive heart disease (HHD), one of the end-organ damage consequences of hypertension, is an important public health issue worldwide. Data on the HHD burden in the Eastern Mediterranean region (EMR) are scarce. We aimed to investigate the burden of HHD in the EMR, its member countries, and globally from 1990 to 2019.

Methods: We used 2019 Global Burden of Disease (GBD) data to report the HHD age-standardised prevalence, disability adjusted life years (DALYs), years of life lost (YLLs), and mortality, as well as HHD risk factors attribution percent with their 95% uncertainty interval (UI). Global data are reported alongside EMR data, and its 22 respective countries. We compared the burden of HHD by socio-demographic index (SDI), sex, age groups, and countries.

Findings: The age-standardised prevalence rate (per 100,000 population) of HHD was higher in the EMR (281.7; 95% UI: 204.5-383.4) in 2019, compared with the global prevalence (233.8; 95% UI: 170.5-312.9). The EMR age-standardised DALYs (per 100,000 population) for HHD in 2019 was 561.9 (361.0-704.1), compared with 268.2 (204.6-298.1) at the global level. There was an increase in HHD prevalence, reduction in mortality, and DALYs between 1990 and 2019 (4.01%, -7.6%, and -6.5%, respectively) in EMR. Among EMR countries, the highest versus lowest rates of age-standardised prevalence, mortality, and DALYs in 2019 [estimate (95% UI)] were in Jordan [561.62 (417.9-747.6)] versus Saudi Arabia [94.9 (69.5-129.0)]; Afghanistan [74.5 (23.7-112.3)] versus Saudi Arabia [4.3 (3.3-5.9)]; and Afghanistan [1374.1 (467.2-2020.7)] versus Qatar [87.11 (64.40-114.29)], respectively.

Interpretation: HHD remains a significant problem in the EMR, with a higher burden than global levels. Serious efforts toward high-quality management and prevention are strongly recommended. Based on this study, our recommendation for the EMR is to adopt effective preventive strategies. For example, promoting healthy dietary patterns and prompt screening for undiagnosed HTN in public places, promoting regular blood pressure measurements at home, and creating community awareness about early detection of HTN.

Funding: None.

Keywords: Disability-adjusted life years; Eastern Mediterranean region; Global burden of disease; Hypertensive heart disease; Years of life lost.

Fig. 1

Trend of age-standardised rate (per 100,000 population) of hypertensive heart disease prevalence (A) mortality (B) and DALYs (C) from 1990 to 2019 in the Eastern Mediterranean region. Data are Eastern Mediterranean region versus global, by sex. Shaded sections indicate 95% uncertainty intervals. DALYs: disability-adjusted life years.

Fig. 2

Status of age-standardised attributable risk for factors associated with hypertensive heart disease based on SDI in Eastern Mediterranean countries in 2019. EMR: Eastern Mediterranean region; SDI: socio-demographic index.

Fig. 3

Scatter plot of age-standardised mortality rate (per 100,000 population) of hypertensive heart disease by country-specific healthcare access and quality index in the Eastern Mediterranean region, 1990–2015. We used healthcare access and quality index presented in Lancet 2017; 390: 231–266 (https://doi.org/10.1016/S0140-6736(17)30818-8) for drawing this figure.