Trends in the global, regional, and national burden of cardiovascular diseases attributed to high systolic blood pressure from 1990 to 2021 and projections to 2045: a systematic analysis based on GBD 2021 data

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide, and high systolic blood pressure (HSBP) is considered among its most critical modifiable risk factors. This study analyzed the temporal trends of the global burden of CVD attributed to HSBP from 1990 to 2021, examined its relationships with age, period, and birth cohort, and projected future trends to 2045.

Methods: The study employed a joinpoint regression model to evaluate the temporal trends of CVD burden attributed to HSBP from 1990 to 2021 and used an Age-Period-Cohort (APC) model to analyze the effects of age, period, and cohort. Additionally, a Bayesian Age-Period-Cohort (BAPC) model was applied to project the disease burden trends up to 2045.

Results: From 1990 to 2021, the absolute number of deaths and DALYs (disability-adjusted life years) of CVD attributed to HSBP increased significantly. However, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed a consistent declining trend. The study highlights significant regional differences, with the disease burden increasing most markedly in regions with a middle Socio-Demographic Index (SDI) and decreasing most significantly in high SDI regions. Additionally, the study revealed gender differences, with the decline in ASMR and ASDR was more pronounced in females, while males exhibited a higher overall disease burden than females. Projections from the BAPC model indicate that from 2022 to 2045, the absolute number of deaths and DALYs will continue to rise, while ASMR and ASDR will decline further.

Conclusions: This study conducted a comprehensive analysis of CVD attributed to HSBP globally, highlighting significant sex, age, and regional differences in disease burden as well as their temporal trends. The findings underscore the importance of targeted prevention strategies, particularly for high-risk populations. This study provides valuable insights for policymakers to formulate effective interventions to reduce the global disease burden.

Keywords: Age-period-cohort analysis; Cardiovascular disease; Global burden; High systolic blood pressure; Projection.

Fig. 1

A The global relationship between SDI levels and the ASMR for CVD attributable to HSBP from 1990 to 2021 (B) The EAPC of ASMR from 1990 to 2021 across seven super GBD regions (C) The global relationship between SDI levels and the ASDR for CVD attributable to HSBP from 1990 to 2021 (D) The EAPC of ASDR from 1990 to 2021 across seven super GBD regions

Fig. 2

World map of ASMR and ASDR to CVD attributable to HSBP in 1990 and 2021, and the change of ASMR and ASDR globally from 1990 to 2021. A ASMR of CVD attributable to HSBP in 1990. B ASMR of CVD attributable to HSBP in 2021. C ASDR of CVD attributable to HSBP in 1990. D ASDR of CVD attributable to HSBP in 2021

Fig. 3

Temporal changes in CVD-related mortality and DALYs attributed to HSBP across all age groups globally from 1990 to 2021. A-C The relative proportion of CVD-related mortality, (D)(E)(F) the temporal changes in the mortality rate of CVD, (G-I) The relative proportion of CVD-related DALYs, J-L The temporal changes in the DALYs rate of CVD

Fig. 4

The local drifts, age effects, period effects, and cohort effects of CVD-related mortality attributable to HSBP worldwide from 1990 to 2021

Fig. 5

The local drifts, age effects, period effects, and cohort effects of CVD-related DALYs attributable to HSBP worldwide from 1990 to 2021

Fig. 6

The joinpoint regression analysis of the age -standardized death rate for CVD attributable to HSBP in global from 1990 to 2021. A The joinpoint regression analysis of the age -standardized death rate for CVD, B The joinpoint regression analysis of the age -standardized death rate for ischemic heart disease, C The joinpoint regression analysis of the age -standardized death rate for ischemic stroke

Fig. 7

The joinpoint regression analysis of the age -standardized DALYs rate for CVD attributable to HSBP in global from 1990 to 2021. A The joinpoint regression analysis of the age -standardized DALYs rate for CVD, B The joinpoint regression analysis of the age -standardized DALYs rate for ischemic heart disease, C The joinpoint regression analysis of the age -standardized DALYs rate for ischemic stroke

Fig. 8

Temporal trend in the number of deaths and ASMR for CVD from 1990 to 2045. A Temporal trend in the number of deaths and ASMR for CVD from 1990 to 2045, B Temporal trend in the number of deaths and ASMR for ischemic heart disease from 1990 to 2045, C Temporal trend in the number of deaths and ASMR for ischemic stroke from 1990 to 2045. Solid lines represent observed ASMR, and dashed lines represent ASMR predicted by the BAPC model

Fig. 9

Temporal trend in the number of DALYs and ASDR for CVD from 1990 to 2045. A Temporal trend in the number of DALYs and ASDR for CVD from 1990 to 2045, B Temporal trend in the number of DALYs and ASDR for ischemic heart disease from 1990 to 2045, C Temporal trend in the number of DALYs and ASDR for ischemic stroke from 1990 to 2045. Solid lines represent observed ASDR, and dashed lines represent ASDR predicted by the BAPC model. Abbreviations: CVD, cardiovascular disease. SDI, socio-demographic index. ASMR, age-standardized mortality rate. ASDR, age-standardized DALYs rate. EAPC, estimated annual percentage change. AAPC, average annual percent change. Solid lines represent observed ASDR, and dashed lines represent ASDR predicted by the BAPC model