AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Projected Burden of Hypertensive Heart Disease in the United States Through 2048: Age-, Sex-, State-, and Risk Factor-Specific Trends from GBD 2023
By Shaik MAH, Majety SK, Garg DA et al.
Introduction/Background: Hypertensive heart disease (HHD) is an increasing cause of cardiovascular morbidity and mortality in the United States. As population aging accelerates, long-term national, state-level, and risk factor-specific projections are needed. Research Question/Hypothesis: We assessed projected U.S. HHD burden through 2048 and identified sex, age, geographic, and risk-factor patterns expected to drive future burden. Methods/Approach: HHD prevalence, death, and disability-adjusted life year (DALY) estimates were obtained from the Global Burden of Disease 2023 study through the Institute for Health Metrics and Evaluation. Historical 1994-2023 data were organized into age- and sex-specific calendar periods. National projections through 2048 were generated using the Nordpred age-period-cohort framework in RStudio with projected U.S. population denominators. State-level prevalence projections were performed for Oklahoma, Louisiana, and the District of Columbia. DALY projections were also generated for GBD-defined HHD risk factors. Results: By 2044-2048, U.S. HHD prevalence is projected to reach 7,023,364.74 cases and 391.38 per 100,000, rising from 4,314,432.63 and 259.17 per 100,000 in 2019-2023. Projected prevalence remains higher among females than males (413.59 vs 355.66 per 100,000). DALYs are projected to more than double from 7,896,985.71 to 16,229,567.70, with rates increasing from 474.37 to 904.40 per 100,000. Males are projected to have higher DALY rates than females by 2044-2048 (979.64 vs 803.90 per 100,000). Deaths are projected to increase from 395,263.92 to 1,041,922.48, with mortality rates rising from 23.74 to 58.06 per 100,000. Mortality rates remain higher among females than males (60.42 vs. 52.80 per 100,000). Across measures, the steepest projected increases occur among adults aged ≥85 years. Louisiana and the District of Columbia are projected to peak around 2034-2038, followed by mild decline, whereas Oklahoma remains near 285 per 100,000 after 2019-2023. Elevated systolic blood pressure remains the leading projected risk factor, with attributable DALYs reaching 16,229,570.25 by 2044-2048, followed by high BMI, low fruit intake, low vegetable intake, non-optimal temperature, alcohol use, and lead exposure. Conclusion(s): U.S. HHD burden is projected to rise substantially through 2048, driven by increasing DALYs, deaths, and aging-related prevalence. The greatest future burden is expected among adults aged ≥85 years, with sex-specific differences across morbidity and mortality. These findings support intensified blood pressure control, obesity prevention, dietary interventions, and targeted planning for high-risk aging populations.