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.

高血压已成为全球首要死因，其中高血压心脏病作为长期高血压的严重后果，其患病率与死亡率不断上升，但相关流行情况及风险因素变迁的研究较少。本研究通过分析全球及中国高血压心脏病流行趋势与风险因素，为制定有效的防治策略提供重要参考。

研究1990—2021年全球与中国高血压心脏病的流行情况与风险因素，并预测其未来的变化趋势。

基于2021年全球疾病负担报告数据，绘制折线图与双向分组条形图呈现不同人群的分布特征，并采用R 4.3.2软件计算1990—2021年全球和中国高血压心脏病年龄标准化率的估计年度百分比变化（EAPC）来量化患病率和死亡率的变化趋势。使用标化死亡率探讨全球及中国高血压心脏病风险因素的变迁情况。利用ARIMA模型预测2022—2030年全球与中国高血压心脏病标化患病率和死亡率的变化情况。

1990—2021年，全球高血压心脏病标化患病率和死亡率EAPC分别为0.56%（0.52%~0.59%）、-0.68%（-0.77%~0.59%），中国高血压心脏病标化患病率和死亡率EAPC分别为-0.68%（-0.90%~0.45%）、-2.68%（-3.05%~2.31%）。2021年中国标化患病率和死亡率分别为192.47/10万、18.85/10万，远高于全球水平（148.32/10万、16.32/10万）。全球及中国老年群体的高血压心脏病患病率和死亡率高于中青年，男性两项指标标化率均高于女性。1990年和2021年，高血压始终居于高血压心脏病死亡风险因素的首位，2021年高钠饮食上升为导致中国高血压心脏病死亡的第二风险因素。预计到2030年，全球及中国高血压心脏病总体标化患病率分别上升至151.52/10万、279.09/10万，而标化死亡率分别下降至12.68/10万、15.27/10万；与全球相比，中国患病和死亡水平更高。

1990—2021年中国高血压心脏病标化患病率和死亡率总体呈下降趋势，但男性和老年人的患病及死亡负担仍十分沉重。高血压和高钠饮食是目前导致中国高血压心脏病患者死亡的重要风险因素。尽管中国在高血压心脏病的防治上取得了显著成效，但预测数据仍显示该疾病的患病和死亡形势严峻。因此，需进一步强化疾病的三级预防策略，尤其要重点关注老年和男性群体，并严格控制高钠饮食等关键风险因素。