Stroke burden attributable to hypertension in G20 countries, 1990–2021: a systematic analysis with forecasts to 2050

Background Hypertension is a leading modifiable risk factor for stroke, which is important for the Group of 20 (G20) countries facing heavy hypertension and stroke prevalence. This study aims to quantify the hypertension-related burden of stroke subtypes, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) across G20 countries from 1990 to 2021 and project trends to 2050. Methods The study utilized data from the GBD 2021 data to assess disability-adjusted Life years (DALYs) and deaths for IS, ICH, and SAH. The future burden was projected using the Autoregressive Integrated Moving Average (ARIMA) model and the Bayesian Age-Period-Cohort (BAPC) prediction model. Results The burden of stroke attributable to hypertension in G20 countries in 2021 was analyzed, including approximately 41.06 million DALYs for IS, 4.52 million for ICH, and 5.58 million for SAH. There were 2.09 million deaths due to IS, 1.93 million due to ICH, and 0.20 million due to SAH. The age-standardized mortality rates (ASMR) for stroke attributable to hypertension increased with age. The burden of IS, ICH, and SAH attributable to hypertension varies among different SDI regions and G20 countries. We estimated that the stroke burden attributable to hypertension would decrease by 2050, albeit less significantly for SAH. Conclusions Despite overall progress, persistent disparities across SDI regions and rising burdens in specific G20 countries underscore the need for targeted management of hypertension and secondary stroke. Future efforts must prioritize regions with worsening trends and population aging, particularly for IS and SAH.