Statistics register — hypertensive heart disease
Last curated: 2026-10-20 (sweep rows resolved live through PubMed E-utilities that day). 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
| HHD deaths, Africa | 246,000 (95% UI 170,000–337,000); 4th-ranked NCD cause of death | Africa, 2023 | GBD 2023 modeled cause of death | GBD 2023 Africa NCD Collaborators 2026, PMID 42767254 |
| High systolic BP share of NCD deaths, Africa | 26.2% (21.6–30.9), the largest attributable risk | Africa, 2023 | Comparative risk assessment | GBD 2023 Africa NCD Collaborators 2026, PMID 42767254 |
| HHD deaths, low- plus lower-middle-SDI countries | 157,950 → 461,110 (~+192%) | 79 countries, 1990–2023 | GBD 2023 secondary analysis | Ruan 2026, PMID 42730369 |
| Age-standardized HHD mortality trend | EAPC +0.58% (0.53–0.63) low-SDI; +0.06% (0.00–0.12) lower-middle-SDI | Same | GBD 2023 secondary analysis | Ruan 2026, PMID 42730369 |
| Prevalent heart failure | 56.0 million (49.9–62.2 million); IHD and HHD the two most common etiologies among older adults | Global, 2023 | GBD 2023 modeled | GBD 2023 Heart Failure Collaborators 2026, PMID 42814432 |
| Target-organ damage, population sample | Any TOD 57.4% (77.3% with hypertension); ECG-LVH 31.1% vs echo-LVH 10.0% | 1,212 adults ≥30, rural Kenya and The Gambia, 2023–2024 | Measured: ABPM, ECG, echo, PWV, renal function | Perkins 2026, PMID 42729214 |
| Hypertension prevalence / care cascade | 37.2% prevalent (WHO 140/90 definition); 58.8% undetected; 50.2% of treated uncontrolled | 1.4 million adults, England, 2022–2025 (volunteer cohort, not a probability sample) | Single-visit clinic BP plus self-report | Liu 2026, PMID 42825274 |
| 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
| 10-mm Hg lower achieved SBP, intensive vs standard target trials | 27 studies; 88,830 participants | RR 0.85 (0.81–0.89); no heterogeneity by CKD | Major cardiovascular events | Iatridi 2026, PMID 42842238 |
| Same | Same | RR 1.42 (1.28–1.58) for ≥30% and 1.47 (1.30–1.66) for ≥40% sustained eGFR decline; kidney failure RR 0.97 (0.84–1.11) | Kidney outcomes | Iatridi 2026, PMID 42842238 |
| 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
| Guideline ECG-LVH criteria vs cardiac CT | 9,392, Copenhagen General Population Study | Sensitivity 20%, specificity 96%; sensitivity 15% women vs 26% men | ECG under-detects LVH, more so in women and overweight | Johansen 2026, PMID 42674294 |
| 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 |
| Prediabetes plus malignant ECG-LVH |
SPRINT secondary analysis, 8,131 adults without diabetes/HF |
Adjusted HF HR 3.55 (1.98–6.36) versus normoglycemia without malignant LVH |
Table 2, model 2; interaction P=0.67 in Results; observational |
Kaze 2026, PMID 42556210 |
| 101-protein HF prediction score |
16,128 hypertensive UK Biobank participants, random 1:1 split |
Adapted PCP-HF C 0.727 → 0.787; ΔC 0.060 (0.040–0.078) |
Tables 2–3; internal validation; comparator omits QRS duration |
Li 2026, PMID 42895254 |
| 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
| Highest vs lowest systolic BP variability | 235,091 Korean AF patients | Stroke aHR 1.211 (1.125–1.304); death 1.189 (1.141–1.239) | Park 2026, PMID 42843353 |
| Highest vs lowest home systolic variability quartile | 4,885 ANAFIE patients ≥75 y | Net stroke/embolism/major-bleeding HR 2.03 (1.21–3.40) | Yoshida 2026, PMID 42722732 |
| Denervation + PVI vs PVI (6 RCTs, n=516, hypertensive) | AF recurrence | RR 0.58 (0.40–0.82) at 12 months; NS at 24 months | Wang 2026, PMID 42851099 |
| 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
| Baxdrostat vs placebo (5 RCTs, n=1,730) | −6.90 mm Hg office SBP (−10.25 to −3.55), I² 74%; hyperkalaemia 8.9% vs 1.2% | Resistant/uncontrolled hypertension | Alper 2026, PMID 42837060 |
| Aldosterone-pathway network (10 RCTs, n=2,865), office SBP vs placebo | Amiloride −14.08; spironolactone −10.78; baxdrostat −9.09; eplerenone −8.14; lorundrostat −6.80 mm Hg | Resistant hypertension | Tsou 2026, PMID 42757615 |
| 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.
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