Disease Burden of Hypertensive Heart Disease among Individuals Aged 60 Years and Older Globally and in China from 1990 to 2021：Analysis of the Global Burden of Disease Database_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jiali ¹ , REN Chunzhen ¹ , LIU Fan ¹ , WANG Keyan ¹ , BI Zhijiang ² , ZHAO Xiaoxiao ³ , KE Lixin ⁴ , WANG Haibo ⁵ , PENG Wenxi ⁶ , WANG Zhifei ⁶ , ZHANG Qiang ⁷ , XU Peng ⁸ , LI Yingdong ^1,9 ,  DENG Xiuxiu ¹ ,  ZHAO Xinke ^1,9 ,  LU Cuncun ^1,9

1. School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, P. R. China;
2. Department of Cardiovascular Medicine, Qinghai Hospital of Traditional Chinese Medicine, Xining, 810000, P. R. China;
3. Geriatric Medicine Center, Affiliated Hospital of Shandong University of TCM, Jinan, 250014, P. R. China;
4. Department of Pediatrics, University of Groningen, Groningen, 9713GZ, Netherlands;
5. Department of Critical Care Medicine, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, 730000, P. R. China;
6. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, P. R. China;
7. The First Affiliated Hospital of Henan University of CM, Zhengzhou, 450000, P. R. China;
8. China Institute for History of Chinese Medicine and Medical Literature, China Academy of Chinese Medical Sciences, Beijing, 100700, P. R. China;
9. Institute of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, P. R. China;

Corresponding?author：

DENG Xiuxiu, Email: lu17metrics@163.com; ZHAO Xinke, Email: xiuxdeng2022@163.com; LU Cuncun, Email: zxkd412@163.com

Keywords：

Hypertensive heart disease; older adults; disease burden; prediction model; age-standardized rate; Global Burden of Disease; sociodemographic index

DOI：

10.7507/1007-4848.202510001

Video：

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Objective To systematically analyze the characteristics of the disease burden of hypertensive heart disease (HHD) in the elderly (≥60 years) globally and in China from 1990 to 2021, and to predict its future trends from 2022 to 2040, with the aim of providing data support for optimizing comprehensive prevention and control strategies for HHD. Methods Based on the Global Burden of Disease (GBD) 2021 database, the number of prevalent cases and disability-adjusted life years (DALYs) of HHD in the elderly were extracted for the world, China, and five regions categorized by sociodemographic index (SDI). Joinpoint regression was used to analyze the temporal trends of age-standardized prevalence rate and age-standardized DALYs rate of HHD in the elderly. A three-factor decomposition method was applied to evaluate the relative contributions of aging, population growth, and epidemiological changes to the variations in the elderly HHD burden. Additionally, a Bayesian age-period-cohort model was used to predict the elderly HHD burden from 2022 to 2040. Results In 2021, the number of prevalent elderly HHD cases reached 10 283 000 globally and 3 412 400 in China, representing increases of 179.20% and 159.20% respectively, compared with 1990. The DALYs of elderly HHD were 18 812 700 person-years globally and 4 731 400 person-years in China, rising by 76.08% and 29.45% respectively from 1990. Meanwhile, the growth rates of the number of prevalent cases and DALYs of elderly HHD varied across different SDI regions. From 1990 to 2021, the age-standardized prevalence rate of elderly HHD in China, as well as the age-standardized DALYs rate of elderly HHD both globally and in China, showed significant downward trends (all average annual percentage changes<0, all P<0.001). In 2021, the 70-74 years age group accounted for the highest proportion of prevalent cases and DALYs of elderly HHD, both globally and in China. Decomposition analysis revealed that population growth was the dominant factor driving the increase in the elderly HHD burden across all regions. The prediction model results indicated that the number of prevalent cases and DALYs of elderly HHD would continue to rise globally and in China from 2022 to 2040, with the growth rate of the elderly HHD burden in China between 2021 and 2040 expected to exceed the global average. Conclusion Over the past 32 years, although the age-standardized disease rates of elderly HHD have mainly shown a downward trend globally and in China, the absolute number of the disease burden has increased substantially. The projection model indicates a continued upward trajectory, with the growth rate in China higher than the global average. Therefore, there is an urgent need to implement precise prevention and control strategies to effectively mitigate the disease burden of elderly HHD.

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1. Masenga SK, Kirabo A. Hypertensive heart disease: risk factors, complications and mechanisms. Front Cardiovasc Med, 2023, 10: 1205475.
2. 楊浩, 何宜, 王芳娟, 等. ARNI與ACEI/ARB對高血壓性心臟病患者左心室舒張功能影響的比較研究. 陸軍軍醫大學學報, 2025, 47(11): 1235-1242.Yang H, He Y, Wang FJ, et al. Comparative effect of ARNI and ACEI/ARB on left ventricular diastolic function in patients with hypertensive heart disease. J Army Med Univ, 2025, 47(11): 1235-1242.
3. González A, Ravassa S, López B, et al. Myocardial remodeling in hypertension. Hypertension, 2018, 72(3): 549-558.
4. Nemtsova V, Vischer AS, Burkard T. Hypertensive heart disease: a narrative review series-part 1: pathophysiology and microstructural changes. J Clin Med, 2023, 12(7): 2606.
5. 馬麗媛, 王增武, 樊靜, 等. 《中國心血管健康與疾病報告2022》要點解讀. 中國全科醫學, 2023, 26(32): 3975-3994.Ma LY, Wang ZW, Fan J, et al. Interpretation of Report on Cardiovascular Health and Diseases in China 2022. Chin Gen Pract, 2023, 26(32): 3975-3994.
6. Murray CJL. The global burden of disease study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
7. 胡守財, 楊成龍, 張領領, 等. 1990—2021年全球及中美兩國歸因于空氣污染的肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2026, 33(1): .Hu SC, Yang CL, Zhang LL, et al. Disease burden and changing trend in tracheal, bronchus, and lung cancer attributable to air pollution globally and in China and the United States from 1990 to 2021. Chin J Clin Thorac Cardiovasc Surg, 2026, 33(1): .
8. Chen X, Giles J, Yao Y, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet, 2022, 400(10367): 1967-2006.
9. Li J, Jiang M, Wang Q, et al. The X-Age Project to construct a Chinese aging clock. Nat Aging, 2025, 5(9): 1669-1685.
10. Hastings MH, Zhou Q, Wu C, et al. Cardiac ageing: from hallmarks to therapeutic opportunities. Cardiovasc Res, 2025, 121(10): 1474-1488.
11. Lacolley P, Avril S, Gáll T, et al. Aging in the vascular system: lessons from mechanobiology, computational approaches, and oxidative stress. Cardiovasc Res, 2025, 121(10): 1566-1581.
12. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
13. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
14. 趙曉曉, 柯立鑫, 荀楊芹, 等. 1990—2021年全球與中國老年2型糖尿病的疾病負擔調查與未來趨勢預測. 中國全科醫學, 2025, 28(16): 2050-2058.Zhao XX, Ke LX, Xun YQ, et al. Investigation and future trend prediction of disease burden of elderly type 2 diabetes mellitus globally and in China from 1990 to 2021. Chin Gen Pract, 2025, 28(16): 2050-2058.
15. 趙曉曉, 盧笑暉, 柯立鑫, 等. 1990—2021年全球與中國老年人群高血壓疾病負擔分析及未來趨勢預測. 協和醫學雜志, 2025, 16(3): 647-658.Zhao XX, Lu XH, Ke LX, et al. Investigation and trend prediction of disease burden of hypertension in the elderly population globally and in China from 1990 to 2021. Med J PUMCH, 2025, 16(3): 647-658.
16. Sun P, Yu C, Yin L, et al. Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021. EClinicalMedicine, 2024, 74: 102713.
17. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
18. Chevan A, Sutherland M. Revisiting Das Gupta: refinement and extension of standardization and decomposition. Demography, 2009, 46(3): 429-449.
19. 龍海, 王曦, 李富, 等. 1990—2021年全球及中美兩國歸因于煙草的肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1255-1262.Long H, Wang X, Li F, et al. Tobacco-attributable lung cancer burden and trends from 1990 to 2021: a global comparison with focus on China and the United States. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1255-1262.
20. Riebler A, Held L. Projecting the future burden of cancer: Bayesian age-period-cohort analysis with integrated nested Laplace approximations. Biom J, 2017, 59(3): 531-549.
21. Huang X, Hu L, Long Z, et al. Hypertensive heart disease: mechanisms, diagnosis and treatment. Rev Cardiovasc Med, 2024, 25(3): 93.
22. Rist A, Sevre K, Wachtell K, et al. The current best drug treatment for hypertensive heart failure with preserved ejection fraction. Eur J Intern Med, 2024, 120: 3-10.
23. 李亞茹, 王婧, 趙麗云, 等. 中國成年人飲酒習慣及影響因素. 中華流行病學雜志, 2018, 39(7): 898-903.Li YR, Wang J, Zhao LY, et al. The drinking status and associated factors in adults in China. Chin J Epidemiol, 2018, 39(7): 898-903.
24. Zhang M, Yang L, Wang L, et al. Trends in smoking prevalence in urban and rural China, 2007 to 2018: findings from 5 consecutive nationally representative cross-sectional surveys. PLoS Med, 2022, 19(8): e1004064.
25. 張振香, 何福培, 張春慧, 等. 慢性病共病患者服藥依從性潛在類別及其影響因素分析. 中國全科醫學, 2022, 25(31): 3904-3913.Zhang ZX, He FP, Zhang CH, et al. Latent class analysis and influencing factors of medication adherence in multiple chronic conditions patients. Chin Gen Pract, 2022, 25(31): 3904-3913.
26. Peng X, Wan L, Yu B, et al. The link between adherence to antihypertensive medications and mortality rates in patients with hypertension: a systematic review and meta-analysis of cohort studies. BMC Cardiovasc Disord, 2025, 25(1): 145.
27. 高血壓藥物治療依從性共識修訂聯合專家委員會. 提高高血壓患者藥物治療依從性和改善血壓控制中國專家共識. 中華高血壓雜志, 2024, 32(3): 205-213.Joint Expert Committee for the Revision of Consensus on Medication Adherence in Hypertension. Chinese expert consensus on improving medication adherence and blood pressure control in hypertensive patients. Chin J Hypertens, 2024, 32(3): 205-213.
28. 劉方舟, 劉可可, 龔建平, 等. 智能化患者服藥提醒App的調研與開發. 中國醫院藥學雜志, 2018, 38(14): 1549-1553.Liu FZ, Liu KK, Gong JP, et al. Research and development of intelligent mobile phone application for medication reminding. Chin Hosp Pharm J, 2018, 38(14): 1549-1553.
29. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet, 2016, 387(10022): 957-967.
30. Liu J, Li Y, Ge J, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet, 2024, 404(10449): 245-255.
31. Guo X, Sun G, Xu Y, et al. Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials. Lancet, 2025, 406(10507): 1009-1019.
32. Wang N, Salam A, Pant R, et al. Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials. Lancet, 2025, 406(10506): 915-925.
33. World Health Organization. Uncontrolled high blood pressure puts over a billion people at risk. [2025-09-23].
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Latest ArticlesDisease Burden of Hypertensive Heart Disease among Individuals Aged 60 Years and Older Globally and in China from 1990 to 2021：Analysis of the Global Burden of Disease Database

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