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. 2025 Apr 26;15(1):14594.
doi: 10.1038/s41598-025-99358-1.

Global burden of hypertensive heart disease and attributable risk factors, 1990-2021: insights from the global burden of disease study 2021

Xiao Wu  1 , JiangMing Sha  1 , QuanZhong Yin  2 , YiHang Gu  2 , XueMing He  3
Affiliations

Global burden of hypertensive heart disease and attributable risk factors, 1990-2021: insights from the global burden of disease study 2021

Xiao Wu et al. Sci Rep. .

Abstract

Hypertensive heart disease (HHD) significantly contributes to global morbidity and mortality, worsened by rising hypertension rates. This study aims to assess the burden of HHD from 1990 to 2021, analyzing prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age, sex, and Sociodemographic Index (SDI). Utilizing data from the Global Burden of Disease 2021 project across 204 countries and 21 regions, the study calculated age-standardized rates and evaluated risk factors for prevention priorities. In 2021, there were 12.5 million HHD cases globally, resulting in 1.332 million deaths and 25.4622 million DALYs. Age-standardized rates were 148.3 for prevalence, 16.3 for deaths, and 301.6 for DALYs per 100,000 people, reflecting increases of 18.2% for prevalence but decreases for deaths (- 22%) and DALYs (- 25.8%) since 1990. Eastern Sub-Saharan Africa recorded the highest prevalence (291.8), while Bulgaria had the highest mortality (103.4) and DALY rates (1739.3). Age-specific trends showed that prevalence, deaths, and DALYs increased with age across genders, and at regional levels, DALYs decreased with higher SDI. Major contributing factors included high systolic blood pressure, metabolic risks, high body-mass index, unhealthy diet, alcohol use, and low fruit and vegetable intake. Despite advances in management, HHD remains a global health concern, especially in low-SDI areas. Efforts focused on modifiable risks, like hypertension control and dietary improvements, are essential to mitigate the burden of HHD.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The University of Washington Institutional Review Board waived the requirement for informed consent to access the GBD data. This research adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

Figures

Fig. 1
Fig. 1
Respectively show the age-standardized point prevalence, Deaths rate, and disability-adjusted life-year rate of HHD in the Global Burden of Disease Study in country in 2021. Age- standardised point prevalence of HHD per 100 000 population in 2021, by country. Generation of the “tmaptools,” “maps,” and “maptools” code packages in R software (version 4.3.3), using data from the Global Burden of Disease. (https://vizhub.healthdata.org/gbd-results?params=gbd-api-2021-public).
Fig. 2
Fig. 2
Respectively show the age-standardized point prevalence, Deaths rate, and disability-adjusted life-year rate of HHD in the Global Burden of Disease Study in country in 2021. Age- standardised death rate of HHD per 100 000 population in 2021, by country. Generation of the “tmaptools,” “maps,” and “maptools” code packages in R software (version 4.3.3), using data from the Global Burden of Disease. (https://vizhub.healthdata.org/gbd-results?params=gbd-api-2021-public).
Fig. 3
Fig. 3
Respectively show the age-standardized point prevalence, Deaths rate, and disability-adjusted life-year rate of HHD in the Global Burden of Disease Study in country in 2021. Age- standardised disability-adjusted life-year rate of HHD per 100 000 population in 2021, by country. Generation of the “tmaptools,” “maps,” and “maptools” code packages in R software (version 4.3.3), using data from the Global Burden of Disease. (https://vizhub.healthdata.org/gbd-results?params=gbd-api-2021-public).
Fig. 4
Fig. 4
Age-specific prevalence, deaths, and disability-adjusted life years (DALYs) of hypertensive heart disease by sex in 2021. Error bars represent the 95% uncertainty interval (UI) of the quantity.
Fig. 5
Fig. 5
Trends in age-standardized disability-adjusted life-year (DALY) rates due to hypertensive heart disease (HHD) for both sexes combined in 21 Global Burden of Disease Study (GBD) regions from 1990 to 2021, stratified by the Socio-demographic Index (SDI). Points from left to right for each region represent annual estimates from 1990 to 2021. The black solid line shows the expected values across the SDI spectrum.
Fig. 6
Fig. 6
Age-standardized DALY rates due to hypertensive heart disease by sex in 204 countries and territories in 2021, standardized by the Socio-demographic Index (SDI). The black solid line represents the expected values along the SDI spectrum.
Fig. 7
Fig. 7
Percentages of disability-adjusted life years (DALYs) due to risk factors for hypertensive heart disease (HHD) in different sexes in Global Burden of Disease Study (GBD) regions in 2021. (A, male. B, female.)
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