Global, regional, and national burdens of hypertensive heart disease from 1990 to 2019 ：A multilevel analysis based on the global burden of Disease Study 2019

Abstract

Aim: This study aimed to describe the prevalence, deaths, and disability-adjusted life-years (DALYs) of hypertensive heart disease (HHD) at the global, regional, and national levels and analyze epidemiological trends.

Method: We extracted global estimates of prevalence, deaths, and DALYs related to HHD in 204 countries and regions from the 2019 Global Burden of Diseases Study. Average annual percent change (AAPC) was calculated to represent temporal trends. Joinpoint regression models were used to analyze time trends from 1990 to 2019. Finally, the decomposition analysis showed the driving factors of burden changes.

Results: From 1990 to 2019, the global prevalence of HHD cases increased by 138 %, reaching 18,598,025 cases (95 % uncertainty interval [UI]: 13,544,365-24,898,411). DALYs also rose by 154 %, reaching 21,508,002 (95 % UI, 16,400,051-23,899,879). The death rate increased to 14.95 (95 % UI, 11.11-16.52) per 100,000 people. Of the five sociodemographic index (SDI) regions, the prevalence rate related to HHD was the highest in the high-middle SDI region. In contrast, the death and DALY rate related to HHD were the highest in the middle SDI region. In other regions, the prevalence rate was the highest in East Asia (548.87 per 100,000 people; 95 % UI, 395.40-747.83), and the death rate was the highest in Central Europe (42.64 per 100,000 people; 95 % UI, 30.58-49.38). At the national level, the Cook Islands had the highest prevalence rate for HHD (703.08 per 100,000 people; 95 % UI, 532.87-920.72), Bulgaria had the highest death rate (75.08 per 100,000 people; 95 % UI, 46.38-92.81), and Afghanistan had the highest DALY rate (1374.12 per 100,000 people; 95 % UI, 467.17-2020.70). High body mass index, a diet high in sodium, alcohol use, lead exposure, high temperature, and low temperature were identified as risk factors for death and DALYs related to HHD in 2019. Aging and population growth were the major drivers of prevalence, death, and DALYs. Finally, over the past 30 years, the global age-standardized prevalence rate (ASPR) of HHD has significantly risen (AAPC = 0.21 %, 95 % confidence interval [CI]: 0.17-0.24; P < 0.001), while the age-standardized deaths rate (ASDR) has shown significant declining trends (AAPC = -0.86 %, 95 % CI: 1.00 to -0.71; P < 0.001), and age-standardized DALY rates (AAPC = -1.08 %, 95 % CI: 1.23 to -0.93; P < 0.001).

Conclusion: Despite a significant decline in the global ASDR and age-standardized DALY rate of HHD over the past 30 years, the ASPR continues to rise. The burden of HHD is more heavily skewed towards non-high-income economies. Active prevention, control of risk factors, and improvement of medical protection levels to address the disease burden caused by population growth and aging are needed.

Keywords: Deaths; Disability-adjusted life-years; Global burden of disease; Hypertensive heart disease; Prevalence.

Fig. 1

Prevalence (A), death (B), and disability-adjusted life-years (DALYs) (C) cases of hypertensive heart disease in 204 countries and territories.

Fig. 2

Age and sex distribution of global Prevalence (A, D), Death (B, E), and Disability-Adjusted Life-Years (DALYs) (C, F) rate (per 100,000 people) of Hypertensive Heart Disease in 1990 (A, B, C) and 2019 (D, E, F).

Fig. 3

The proportion of Hypertensive Heart Disease Deaths and Disability-Adjusted Life-Years (DALYs) Attributable to Risk Factors.

Fig. 4

Changes in Hypertensive Heart Disease Of Prevalence (A), Death (B), and Disability-Adjusted Life-Years (DALYs) (C) according to population-level determinants of population growth, aging, and epidemiological change from 1990 to 2019 at the global level and five Sociodemographic Index (SDI) region.

Fig. 5

Joinpoint regression analysis of ASPR (A), ASDR (B), Age-standardized DALYs Rate (C) of Hypertensive Heart Disease at the global level and five Sociodemographic Index (SDI) region (Global-Dark blue, High SDI-Red, High-middle SDI-Green, Middle SDI-Light blue, Low-middle SDI-Purple, Low SDI-Orange) levels from 1990 to 2019. Abbreviations: ASPR, age-standardized prevalence rate; ASPR, age-standardized deaths rate.