Statistics register — hypertensive heart disease¶
Last curated: 2026-08-31. This register preserves denominator, population, measurement, year, and uncertainty. Every PMID was resolved through live PubMed E-utilities during this build. Values are not interchangeable across office, automated office, home, ambulatory, ECG, echo, or CMR methods.
Global and population burden¶
| Quantity | Estimate | Population / period | Method | Source |
|---|---|---|---|---|
| Adults aged 30–79 with hypertension | 1.28 billion | Global, 2019 | Pooled population studies | NCD-RisC 2021, PMID 34450083 |
| Proportion living in LMICs | ~82% | Global, 2019 | Pooled population studies | NCD-RisC 2021, PMID 34450083 |
| Women with hypertension | 626 million | Global, 2019 | Pooled population studies | NCD-RisC 2021, PMID 34450083 |
| Men with hypertension | 652 million | Global, 2019 | Pooled population studies | NCD-RisC 2021, PMID 34450083 |
| Hypertension control among affected women | 23% | Global, 2019 | Standardized survey synthesis | NCD-RisC 2021, PMID 34450083 |
| Hypertension control among affected men | 18% | Global, 2019 | Standardized survey synthesis | NCD-RisC 2021, PMID 34450083 |
| Global risk-factor burden framing | 88 risk factors assessed | 204 countries/territories, 1990–2021 | Comparative risk assessment | GBD 2021, PMID 38762324 |
| Raised systolic BP burden trend | Remained a leading attributable risk | Global, 1990–2021 | Comparative risk assessment | GBD 2021, PMID 38762324 |
| Prevalence gap by wealth | Control improved mainly in high-income settings | Global, 1990–2019 | Repeated pooled surveys | NCD-RisC 2021, PMID 34450083 |
| Guideline implementation gap | Marked between HIC and LMIC settings | Cross-country | Narrative/policy analysis | Schutte 2017, PMID 27698059 |
| HHD share of acute HF (clinically assigned) | 576 / 1,578 (36.5%) — leading aetiology, ahead of cardiomyopathy (23.4%) and ischaemic heart disease (23.3%) | 50 hospitals, 17 African countries, Jul 2024–Jul 2025 | Prospective observational cohort of acute-HF presentations; hospital denominator, not population | Sliwa 2026, PMID 42669305 |
| Acute-HF presentation rate | 0.03 per 10,000 adults per week (95% CI 0.02–0.05); 0.02 (0.01–0.04) for de novo | Same cohort, adult catchment populations | Seven 24-hour surveillance periods in an 8-week site window | Sliwa 2026, PMID 42669305 |
| Acute-HF mortality in that cohort | In-hospital 8.7% (7.3–10.2); 30-day 11.1% (9.6–12.9); 180-day 20.6% (18.4–23.0) | Median age 56.0 years (IQR 40.0–69.0) | 33.7% lost to follow-up before 180 days — bounds the estimate | Sliwa 2026, PMID 42669305 |
HHD coding and case-definition instability¶
| Quantity | Estimate / finding | Population | Method | Source |
|---|---|---|---|---|
| HHD case definition | No single universally operationalized definition | Clinical literature | Review | Nwabuo 2020, PMID 32016791 |
| HHD attribution | Depends on definition and exclusion of competing cardiac causes | Clinical literature | Pathophysiology review | Nwabuo 2020, PMID 32016791 |
| ECG-LVH sensitivity | Generally low across common criteria | Hypertensive adults | Systematic review | Pewsner 2007, PMID 17726091 |
| ECG-LVH specificity | Generally high, criterion-dependent | Hypertensive adults | Systematic review | Pewsner 2007, PMID 17726091 |
| ECG versus imaging phenotype | ECG criteria are insensitive for anatomical LVH | Hypertensive cohorts | Systematic review | Pewsner 2007, PMID 17726091 |
| CMR diagnostic role | Highest reproducibility for mass and tissue characterization | Imaging cohorts | Review | Ismail 2023, PMID 37176563 |
Blood-pressure reduction and cardiovascular outcomes¶
| Exposure / trial | Population | Effect estimate | Outcome | Source |
|---|---|---|---|---|
| 10-mm Hg systolic reduction | 123 studies; 613,815 participants | RR 0.80 (95% CI 0.77–0.83) | Major cardiovascular disease | Ettehad 2016, PMID 26724178 |
| 10-mm Hg systolic reduction | Same meta-analysis | RR 0.73 (0.68–0.77) | Stroke | Ettehad 2016, PMID 26724178 |
| 10-mm Hg systolic reduction | Same meta-analysis | RR 0.72 (0.67–0.78) | Heart failure | Ettehad 2016, PMID 26724178 |
| 5-mm Hg systolic reduction | Individual-participant meta-analysis | ~10% relative reduction | Major cardiovascular events | BPLTTC 2021, PMID 33933205 |
| Benefit by prior CVD | With and without previous cardiovascular disease | Directionally consistent | Major cardiovascular events | BPLTTC 2021, PMID 33933205 |
Intensive-target trials¶
| Trial / outcome | Intensive | Comparator | Effect | Source |
|---|---|---|---|---|
| SPRINT participants | 9,361 | — | Randomized | SPRINT 2015, PMID 26551272 |
| SPRINT achieved SBP, year 1 | 121.4 mm Hg | 136.2 mm Hg | Difference 14.8 mm Hg | SPRINT 2015, PMID 26551272 |
| SPRINT primary outcome, initial | 1.65%/yr | 2.19%/yr | HR 0.75 (0.64–0.89) | SPRINT 2015, PMID 26551272 |
| SPRINT all-cause mortality, initial | — | — | HR 0.73 (0.60–0.90) | SPRINT 2015, PMID 26551272 |
| SPRINT primary outcome, final | 1.77%/yr | 2.40%/yr | HR 0.73 (0.63–0.86) | SPRINT final 2021, PMID 34010531 |
| SPRINT mortality, final | 1.06%/yr | 1.41%/yr | HR 0.75 (0.61–0.92) | SPRINT final 2021, PMID 34010531 |
| STEP participants | 8,511 | — | Age 60–80, China | STEP 2021, PMID 34491661 |
| STEP achieved SBP, year 1 | 127.5 mm Hg | 135.3 mm Hg | Difference 7.8 mm Hg | STEP 2021, PMID 34491661 |
| STEP primary composite | 3.5% | 4.6% | HR 0.74 (0.60–0.92) | STEP 2021, PMID 34491661 |
| STEP stroke | — | — | HR 0.67 (0.47–0.97) | STEP 2021, PMID 34491661 |
| STEP acute decompensated HF | — | — | HR 0.27 (0.08–0.98) | STEP 2021, PMID 34491661 |
| ACCORD BP primary outcome | Intensive | Standard | HR 0.88 (0.73–1.06) | ACCORD 2010, PMID 20228401 |
| ACCORD BP stroke | Intensive | Standard | HR 0.59 (0.39–0.89) | ACCORD 2010, PMID 20228401 |
| ACCORD treatment-attributed serious adverse events | 3.3% | 1.3% | Absolute +2.0 points | ACCORD 2010, PMID 20228401 |
LVH and remodeling¶
| Study / marker | Population | Estimate | Interpretation | Source |
|---|---|---|---|---|
| LIFE participants | 9,193 | Hypertension + ECG-LVH | Phenotype-enriched RCT | Dahlöf 2002, PMID 11937178 |
| LIFE primary composite | Losartan vs atenolol | RR 0.87 (0.77–0.98) | Similar achieved brachial BP | Dahlöf 2002, PMID 11937178 |
| LIFE stroke | Losartan vs atenolol | RR 0.75 (0.63–0.89) | Major driver of composite | Dahlöf 2002, PMID 11937178 |
| LIFE echo LV-mass-index change | Losartan vs atenolol | −21.7 vs −17.7 g/m²; P=0.021 | Greater regression | Devereux 2004, PMID 15326072 |
| Regression prognosis meta-analysis | 5 studies; 3,149 patients | HR 0.54 (0.35–0.84) | Regression/persistent normal vs persistent/new LVH | Pierdomenico 2010, PMID 20414193 |
| ARNI vs olmesartan, week 12 | 114 participants | −6.36 vs −2.32 g/m² | CMR LV-mass index | Schmieder 2017, PMID 29029087 |
| ARNI vs olmesartan, week 52 | Same trial | −6.83 vs −3.55 g/m² | CMR LV-mass index | Schmieder 2017, PMID 29029087 |
| REVERSE-LVH participants | 78 | CMR-LVH | Phase 2 RCT | Lee 2025, PMID 40739095 |
| REVERSE-LVH interstitial volume | ARNI vs valsartan | −5.2±5.4 vs −2.5±3.1 mL; P=0.006 | Similar 52-week ambulatory SBP | Lee 2025, PMID 40739095 |
| STEP LVH analysis | Older hypertensive adults | Intensive treatment improved LVH endpoints | Secondary trial analysis | Deng 2023, PMID 37259845 |
Biomarkers and imaging prognostication¶
| Marker / model | Cohort | Estimate | Boundary | Source |
|---|---|---|---|---|
| REMODEL cohort | 1,054 asymptomatic adults | Prospective follow-up | Essential hypertension | Sharp 2026, PMID 41771092 |
| NT-proBNP threshold | REMODEL derivation | 152 pg/mL | Internally selected | Sharp 2026, PMID 41771092 |
| hs-troponin T threshold | REMODEL derivation | 12.7 pg/mL | Internally selected | Sharp 2026, PMID 41771092 |
| Both markers elevated | REMODEL | HR 17.11 (8.12–36.09) | Requires external validation | Sharp 2026, PMID 41771092 |
| CMR phenotype prognosis | HHD cohort | Phenotype-specific risk separation | Recent, needs replication | Lertsiripatarajit 2026, PMID 41953289 |
| LV mass-to-strain ratio | HHD cohort | Incremental prognostic candidate | No treatment threshold | Hwang 2025, PMID 40970541 |
| GLS in hypertension | Imaging literature | Impairment can precede reduced EF | Load/vendor dependent | Ismail 2023, PMID 37176563 |
| Fibrosis markers | HHD literature | Associations across serum and CMR measures | No interchangeable cutoff | González 2024, PMID 38084597 |
Atrial fibrillation and rhythm¶
| Association / intervention | Population | Effect / finding | Source |
|---|---|---|---|
| BP and incident AF | Prospective cohorts | Dose-related positive association | Aune 2023, PMID 36626102 |
| Losartan strategy and new AF | LIFE population | Reduced new-onset AF | Wachtell 2005, PMID 15734615 |
| Lower left-atrial diameter during treatment | LIFE | Associated with less new AF | Wachtell 2010, PMID 20438307 |
| ECG/imaging LVH and incident AF | MESA | Positive association | Chrispin 2014, PMID 24657688 |
| Renal denervation plus AF ablation | ERADICATE-AF | Reduced AF recurrence signal | Steinberg 2020, PMID 31961420 |
| Renal denervation across hypertension trials | Meta-analysis | BP-lowering signal with heterogeneity | Vukadinović 2024, PMID 39355923 |
Lifestyle and food-environment interventions¶
| Intervention | Evidence base | Effect estimate | Outcome / boundary | Source |
|---|---|---|---|---|
| DASH dietary pattern | RCT meta-analysis | −3.2 mm Hg systolic approximately | Mean effect; baseline BP varies | Filippou 2020, PMID 32330233 |
| Sodium reduction | Dose-response meta-analysis | Greater reduction with greater sodium reduction | BP; context-dependent adherence | Filippini 2021, PMID 33586450 |
| Exercise training | RCT meta-analysis | Significant office and ambulatory BP lowering | Modality/intensity heterogeneous | Cornelissen 2013, PMID 23525435 |
| Weight loss | RCT meta-analysis | −1.05 mm Hg SBP/kg | Average linear estimate | Neter 2003, PMID 12975389 |
| Weight loss | Same analysis | −0.92 mm Hg DBP/kg | Average linear estimate | Neter 2003, PMID 12975389 |
| SSaSS participants | 600 villages; 20,995 adults | Mean 4.74-year follow-up | Rural China, high-risk | Neal 2021, PMID 34459569 |
| SSaSS stroke | Salt substitute vs usual salt | RR 0.86 (0.77–0.96) | Primary outcome | Neal 2021, PMID 34459569 |
| SSaSS major CVD | Same | RR 0.87 (0.80–0.94) | Composite | Neal 2021, PMID 34459569 |
| SSaSS death | Same | RR 0.88 (0.82–0.95) | All-cause death | Neal 2021, PMID 34459569 |
| SSaSS serious hyperkalemia | Same | RR 1.04 (0.80–1.37) | No significant difference | Neal 2021, PMID 34459569 |
| Village-doctor intervention | Rural China | Improved BP control | Cluster delivery model | Sun 2022, PMID 35500594 |
| Home-based care | Rural South Africa | Improved hypertension outcomes | Health-system delivery | Siedner 2025, PMID 40888742 |
| CRHCP 7-year BP | 138.8/80.7 vs 152.3/86.1 mm Hg (difference −13.5/−5.4, P<0.0001) | 326 villages, 33,995 adults ≥40 y, rural China | Cluster-randomized; nonphysician-led intensive target <130/80 | Sun 2026, PMID 42666029 |
| CRHCP 7-year CVD composite | 2.4% vs 3.0% per person-year; HR 0.76 (95% CI 0.72–0.81) | Same | MI, stroke, HF hospitalization, CV death | Sun 2026, PMID 42666029 |
| CRHCP 3-year post-trial period | 3.4% vs 4.2% per person-year; HR 0.79 (0.73–0.85) | Same, years 4–7 after subsidy/incentive withdrawal | Effect persisted without free medication or performance incentives | Sun 2026, PMID 42666029 |
| CRHCP harms over 7 years | Hypotension RR 1.58 (1.39–1.79); mild hypokalemia RR 1.38 (1.23–1.56) | Same | Both P<0.001 | Sun 2026, PMID 42666029 |
Resistant and secondary hypertension¶
| Quantity | Estimate | Setting | Source |
|---|---|---|---|
| PATHWAY-2 spironolactone vs placebo | −8.70 mm Hg home SBP (95% CI −9.72 to −7.69) | Confirmed resistant hypertension | Williams 2015, PMID 26414968 |
| PATHWAY-2 vs mean active comparators | −4.26 mm Hg (−5.13 to −3.38) | Bisoprolol/doxazosin comparison | Williams 2015, PMID 26414968 |
| Primary aldosteronism cardiovascular risk | Higher than essential hypertension at comparable BP | Systematic review/meta-analysis | Monticone 2018, PMID 29129575 |
| OSA and concentric LVH | Positive pooled association | Meta-analysis | Cuspidi 2020, PMID 31863113 |
| True versus apparent resistance | Requires adherence and out-of-office BP confirmation | Clinical review | Sarathy 2022, PMID 35227430 |
Harms and safety¶
| Harm | Comparison / estimate | Population | Source |
|---|---|---|---|
| SPRINT hypotension | More frequent with intensive treatment | High-risk adults without diabetes/stroke | SPRINT 2015, PMID 26551272 |
| SPRINT syncope | More frequent with intensive treatment | Same | SPRINT 2015, PMID 26551272 |
| SPRINT electrolyte abnormality | More frequent with intensive treatment | Same | SPRINT 2015, PMID 26551272 |
| SPRINT AKI/failure | More frequent with intensive treatment | Same | SPRINT 2015, PMID 26551272 |
| SPRINT injurious falls | Not significantly increased initially | Same | SPRINT 2015, PMID 26551272 |
| ACCORD treatment-attributed serious events | 3.3% vs 1.3% | Type 2 diabetes | ACCORD 2010, PMID 20228401 |
| Spironolactone hyperkalemia | Requires potassium/renal monitoring | Resistant hypertension | PATHWAY-2, PMID 26414968 |
| Salt-substitute serious hyperkalemia | RR 1.04 (0.80–1.37) | Rural high-risk population | Neal 2021, PMID 34459569 |
| Hypertensive crisis frequency in older ED patients | 186 / 25,557 visits = 0.73% (95% CI 0.63–0.84); women 0.87%, men 0.56% (OR for men 0.64, 0.47–0.87) | Adults ≥65 y, 52 Spanish public hospitals, one-week recruitment | Retrospective analysis of the multipurpose EDEN cohort |
| Hypertensive crisis annual rate | 429 per 100,000 older inhabitants (371–493); men 341 (267–436), women 493 (413–590) | Spanish population ≥65 y | Extrapolated from the one-week ED sample; not a measured incidence |
| Hypertensive crisis outcome | Hospitalization 7.5%, ICU 0.5%, in-hospital death 1.1%; 1-year combined adverse event 57.9% (men 65.6%, women 52.5%; adjusted HR 1.61, 1.01–2.57) | Same | Low acute hospitalization and ICU use, but high one-year revisit/hospitalization/death |
Conflicts that should remain visible¶
| Question | Estimate A | Estimate B | Why both can be true |
|---|---|---|---|
| Does intensive BP control reduce events? | SPRINT primary HR 0.75 (0.64–0.89), PMID 26551272 | ACCORD primary HR 0.88 (0.73–1.06), PMID 20228401 | Populations, diabetes status, power and endpoint composition differ |
| Is LVH regression causal? | Regression associated with HR 0.54 (0.35–0.84), PMID 20414193 | No randomized treat-to-regression event trial | Association may include achieved BP, adherence and baseline-risk effects |
| Is dual-biomarker staging decisive? | HR 17.11 (8.12–36.09), PMID 41771092 | No external calibration or treatment-utility trial | Strong prognostic separation is not the same as actionable prediction |
| Is potassium salt universally safe? | Serious hyperkalemia RR 1.04 (0.80–1.37), PMID 34459569 | CKD/medication-specific risk remains | Trial setting and event ascertainment do not cover every clinical subgroup |
| Does ARNI reverse HHD beyond BP? | Interstitial-volume difference P=0.006, PMID 40739095 | No clinical-event evidence | Surrogate improvement may or may not mediate outcomes |
Interpretation rules¶
- Preserve absolute event rates alongside relative effects whenever available.
- Do not transfer standardized automated-office targets directly to casual office readings.
- Distinguish prevalent hypertension, coded HHD, imaging LVH, and clinical HF denominators.
- Treat internally derived biomarker cutoffs as hypotheses until externally calibrated.
- Do not call an observational regression association a mediated treatment effect.
- Report confidence intervals; a point estimate without uncertainty is incomplete.
- Separate population prevention effectiveness from efficacy in tightly monitored trials.
- Keep kidney function, potassium risk, orthostasis, frailty, pregnancy, and drug interactions visible.
- For clinical use, check the current primary guideline and local formulary rather than relying on this static register.