Abstract Body: Introduction: Lead exposure (LE) has been increasingly recognized as a significant risk factor for hypertensive heart disease (HHD), with no safe threshold identified for its adverse health effects. Persistent environmental contamination from sources such as old paint and industrial emissions continues to pose cardiovascular risks.

Method: Using Burden of Disease Study 2021 tool, we estimated deaths and disability due to HHD attributable to LE by age, sex, year and location across the 204 countries and territories from 1990-2021. Results are shown in absolute counts and unadjusted rates (per 100,000).

Results: From 1990 to 2021, the average annual percentage change (APC) in the absolute death count rose by 1.97%, disability-adjusted life years (DALYs) increased by 1.31%, and years lived with disability (YLDs) by 3%. Regionally, the highest increase in APC for deaths was observed in high-income countries at 3.54%, followed by high-SDI regions and South Asia, both at 2.95%. Regarding age, the highest number of deaths occurred in the 80-84 age group, totaling 216,409 (95% uncertainty interval: 179,011-244,186). The highest DALYs were noted in the 70-74 age group, at 3.3 million (2.8-3.7 million), and YLDs in the same age group were 178,655 (102,947-280,059). From 1990 to 2021, females saw higher total percentage changes (TPC) compared to males: deaths increased by 92% vs. 74%, DALYs by 57% vs. 43%, and YLDs by 170% vs. 134%.

Conclusion: Deaths due to HHD attributable to LE accounted for 23.93% of all HHD related deaths globally in 2021. The persistent burden of HHD attributable to LE highlights a critical area for public health intervention. Reducing exposure to lead and mitigating its cardiovascular effects are imperative for global health security.