Hypertensive nephropathy, a common chronic kidney disease, is a significant contributor to end-stage renal disease. Analyzing and predicting its epidemiological trends is crucial for the prevention and control of chronic kidney disease.

This study aims to analyze the temporal trends in the incidence and mortality of hypertensive nephropathy in China from 1990 to 2021 and to provide a theoretical basis for developing prevention and control strategies.

Data on the incidence and mortality of hypertensive nephropathy in China were obtained from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression models were used to analyze the average annual percentage change (AAPC) in incidence and mortality. Age-period-cohort models were applied to estimate the age, period, and cohort effects by gender. Bayesian age-period-cohort (BAPC) methods were employed to predict the standardized incidence and mortality rates for both genders from 2022 to 2032.

After age standardization, the age-standardized incidence rates (ASIR) for both males and females showed a slight decline from 1990 to 1995, followed by a gradual increase. The age-standardized mortality rate (ASMR) for males decreased from 5.44 per 100 000 in 1990 to 4.72 per 100 000 in 2021, while for females, it decreased from 3.86 per 100 000 to 2.75 per 100 000, with a more pronounced decline in females. Joinpoint regression analysis indicated an overall increasing trend in ASIR (AAPC for males: 0.43%, females: 0.64%, P<0.05). The fastest decline in male ASIR occurred from 1990 to 1992 (APC=-1.62%, P<0.05), while the fastest increase was from 2019 to 2021 (APC=1.30%, P<0.05). For females, the fastest decline in ASIR was from 1990 to 1995 (APC=-1.31%, P<0.05). Overall, the ASMR rate showed a decreasing trend (AAPC for males: -0.51%, females: -1.09%, P<0.05), with a more significant decline in females. The fastest decline in male ASMR was from 2004 to 2007 (APC=-3.26%, P<0.05), while the fastest increase was from 1998 to 2004 (APC=1.30%, P<0.05). For females, the fastest decline in ASMR was also from 2004 to 2007 (APC=-4.47%, P<0.05). Age-period-cohort analysis revealed that males generally had higher incidence and mortality rates than females across all age groups, with rates increasing with age. The incidence growth accelerated after age 60-65, and mortality growth accelerated after age 70. The period effect on incidence risk was slightly higher in females than in males, while the cohort effect showed an overall increasing trend in incidence and a decreasing trend in ASMR for both genders. Predictions from 2022 to 2032 indicate a continued rise in ASIR and a sustained decline in mortality for both genders.

From 1990 to 2021, the ASIR of hypertensive nephropathy in China showed an overall upward trend, while ASMR decreased. Both incidence and mortality increased with age, particularly in the elderly. Over the next decade, ASIR is expected to continue rising, while ASMR will decline slowly. These findings suggest a need to focus on male and elderly patients in developing targeted prevention and control measures.

高血压肾病作为一种常见的慢性肾脏病，已成为导致终末期肾病的重要病因，分析和预测其流行现状能为慢性肾病的防控提供一定参考。

本研究旨在分析1990—2021年我国高血压肾病发病率和死亡率的时间变化趋势，为未来我国高血压肾病防控策略的制订提供理论依据。

利用2021年全球疾病负担（GBD 2021）数据库获取我国高血压肾病发病率和死亡率数据，应用Joinpoint回归模型分析高血压肾病发病率和死亡率的平均年度变化百分比（AAPC）的变化趋势，使用年龄-时期-队列模型估计不同性别高血压肾病年龄、时期和队列效应，并采用贝叶斯年龄-时期-队列（BAPC）方法对我国2022—2032年不同性别高血压肾病标化发病率和死亡率做出预测。

经过年龄标准化后，男性和女性年龄标准化发病率（ASIR）在1990—1995年均略有下降，随后均呈现缓慢上升趋势；1990—2021年男性的年龄标准化死亡率（ASMR）由5.44/10万下降至4.72/10万，女性由3.86/10万下降至2.75/10万，女性的下降趋势相对更加明显。Joinpoint回归模型结果显示，经年龄标准化后，我国高血压肾病的ASIR整体呈上升趋势（男性、女性AAPC分别为0.43%、0.64%，P<0.05）。不同时期结果显示，我国男性高血压肾病ASIR 1990—1992年降速最快[年度变化百分比（APC）=-1.62%，P<0.05]，2019—2021年增速最快（APC=1.30%，P<0.05）。我国女性高血压肾病ASIR 1990—1995年降速最快（APC=-1.31%，P<0.05）。经年龄标准化后，我国高血压肾病的ASMR整体呈下降趋势（男性AAPC=-0.51%，女性AAPC=-1.09%，P<0.05），女性下降趋势更加明显。不同时期分析结果显示，我国男性高血压肾病ASMR 2004—2007年降速最快（APC=-3.26%，P<0.05），1998—2004年增速最快（APC=1.30%，P<0.05）。我国女性高血压肾病ASMR 2004—2007年降速最快（APC=-4.47%，P<0.05）。年龄-时期-队列模型分析结果显示，在所有年龄组中，男性的高血压肾病ASIR和ASMR普遍高于女性，高血压肾病发病率和死亡率均随年龄增长呈上升趋势，年龄60~65岁后男性和女性ASIR增速均开始加快，年龄≥70岁后死亡率增速开始加快。我国男性和女性高血压肾病发病风险的时期效应呈现上升趋势，时期对女性高血压肾病发病风险的影响稍高于男性；1992—2021年我国男性和女性高血压肾病的死亡风险随时间推移而出现下降的趋势；我国男性和女性高血压肾病ASIR的队列效应总体呈现上升趋势，ASMR的队列效应总体呈现下降趋势。2022—2032年我国男性、女性高血压肾病的ASIR将会持续上升，ASMR将会持续下降。

1990—2021年我国高血压肾病ASIR总体呈上升趋势，ASMR呈下降趋势；发病和死亡风险均随年龄而增长，尤其在老年后增速明显。预测未来10年，ASIR将会持续上升，ASMR缓慢下降。提示应该关注男性和老年患者，有针对性地制订防控措施。