Hypertension has emerged as the leading global cause of mortality, with hypertensive heart disease(HHD) representing one of its most severe long-term complications. Despite rising trends in HHD prevalence and mortality globally and in China, comprehensive analyses of its epidemiological patterns and evolving risk factors remain limited. This study aims to characterize the historical trends and risk factors associated with HHD globally and in China, providing evidence to guide effective prevention and control strategies.

To characterize the epidemiological patterns and identify key risk factors of HHD both globally and in China from 1990 to 2021, and to forecast future trends in its burden.

Data were obtained from the Global Burden of Disease Study 2021. Line charts and grouped bars plots were uesd to illustrate demographic and temporal distribution patterns. The estimated annual percentage change(EAPC) in age-standardized prevalence and mortality rates was calculated using R software(version 4.3.2). Changes in risk factor contributions over time were assessed using standardized mortality data. An ARIMA model was employed to forecast trends in HHD burden from 2022 to 2030.

Between 1990 to 2021, the global age-standardized prevalence rate of HHD increased slightly [EAPC=0.56%(0.52% to 0.59%)], while the mortality rate showed a slight decline [EAPC=-0.68%(-0.77% to 0.59%)]. In contrast, China experienced a significant decrease in both prevalence [EAPC=-0.68%(-0.90% to 0.45%)] and mortality [EAPC=-2.68%(-3.05% to 2.31%)]. In 2021, China's age-standardized prevalence and mortality rates were 192.47 and 18.85 per 100 000 population, respectively-substantially higher than global averages of 148.32 and 16.32 per 100 000. Both globally and in China, the burden of HHD was disproportionately higher among older adults compared to younger individuals, and in males compared to females. Throughout the study period, high blood pressure remained the leading risk factor for HHD-related mortality. By 2021, high dietary sodium intake had become the second most important contributor to HHD mortality in China. Projections suggested that by 2030, the global prevalence would rise marginally to 151.52 per 100 000, while China was expected to increase markedly to 279.09 per 100 000. Mortality rates were projected to decline further, reaching 12.68 per 100 000 globally and 15.27 per 100 000 in China.

While China has made considerable progress in reducing the overall burden of HHD since 1990, the disease remains a major public health concern, especially among elderly individuals and men. High blood pressure and high dietary sodium intake are currently important risk factors contributing to HHD mortality. Although China has achieved significant progress in the prevention and treatment of HHD, projected data still indicate a substantial burden of the disease in terms of prevalence and mortality. Therefore, it is necessary to further strengthen comprehensive prevention strategies across all stages of the disease continuum, with particular attention directed toward high-risk populations such as the elderly and males, as well as more effective management of key modifiable risk factors, including excessive dietary sodium intake.