Annals of Medicine and Surgery · Oct 13, 2026
Health inequalities in high systolic blood pressure-attributable ischemic stroke: global burden trends and projections to 2050
By Ma Y, Li D, Sun F et al.
Background: High systolic blood pressure (HSBP) is a major risk factor for ischemic stroke (IS), promoting atherosclerosis, vessel occlusion, cerebral small-vessel damage, and thrombosis. However, data on the temporal evolution of HSBP-attributable IS burden are limited. This study analyzes the global HSBP-attributable IS burden from 1990 to 2021, assessing age, period, and cohort effects. Methods: Using Global Burden of Disease Study 2021 data, we examined age- and sex-specific IS mortality and disability-adjusted life years (DALYs) as age-standardized rates. The Socio-demographic Index (SDI) was used to assess development levels. Health inequalities were measured with the Slope and Concentration indices. Frontier analysis identified optimal outcomes, decomposition analysis isolated temporal drivers, joinpoint regression evaluated trends, and Bayesian age-period-cohort models projected future trajectories. Results: From 1990 to 2021, global HSBP-attributable IS DALYs and deaths rose 55.4% and 53.0%, respectively, but age-standardized DALY and mortality rates fell 34.6% and 40.3%. Declines were greatest in high-SDI regions and minimal in low- and low-middle-SDI areas, with increases observed in some Sub-Saharan African regions. North Macedonia had the highest burden, and Singapore the lowest. Males faced a higher burden before age 79, whereas females did after. Population growth and aging drove absolute increases, while epidemiological improvements reduced rates. Inequalities widened, concentrating the burden in low-SDI regions. Projections suggest continued rate declines by 2050 but a rising absolute burden. Conclusion: Despite declining age-standardized rates, the HSBP-attributable IS burden grew due to demographic shifts. Persistent inequalities underscore the need for enhanced HSBP prevention in low- and middle-SDI regions, and for health system adaptations for aging populations, to reduce the global impact of stroke.