Global, Regional, and National Burden of Stroke Attributable to High Systolic Blood Pressure in Adults Aged 45 Years and Above From 1990 to 2021, with Projections to 2045: A Systematic and Comprehensive Analysis of the Global Burden of Disease Study 2021.

INTRODUCTION: Stroke remains a leading cause of death and disability worldwide, with high systolic blood pressure (HSBP) being a major modifiable risk factor. This study aimed to assess global trends, age- and SDI-specific patterns, and future projections of the stroke burden attributable to HSBP among adults aged≥45 years from 1990 to 2021. METHODS: Data were obtained from the Global Burden of Disease Study 2021. Mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) were analyzed across sex, age, and socio-demographic index (SDI) strata. Estimated annual percentage change (EAPC) was used to quantify temporal trends, and the ARIMA model was applied for projections to 2045. RESULTS: In 2021, global HSBP-attributable stroke deaths and DALYs among adults aged≥45 years reached 4.12 million and 86.18 million, respectively. From 1990 to 2021, the number of deaths increased by 51.5% and DALYs by 47.9%, despite declines in ASMR (EAPC=-1.72) and ASDR (EAPC=-1.61). Mortality and DALY rates increased with age in all SDI regions, peaking at 70-79 years, with low-SDI regions showing the highest rates and an earlier peak age. High-SDI regions recorded the lowest burden and largest declines in ASMR and ASDR. Projections indicate a continued global decline in mortality rates through 2045, with a faster reduction in females. CONCLUSION: Although the global age-standardized burden of HSBP-attributable stroke has declined, absolute cases continue to rise, especially among older adults and in low-SDI regions, highlighting the need for targeted prevention.