Abstract Body: Background: Hypertensive heart disease (HHD) stands as the ninth leading cause of mortality within the United States (US). Despite its significant impact, previous research has lacked consistent and comparative assessments of HHD across the nation. Thus, this study represents a pioneering effort, providing the first-ever comprehensive estimation of the HHD burden in the US over the past three decades, encompassing the initial two years of the COVID-19 pandemic, a period marked by considerable challenges in managing non-COVID-19 ailments.

Method: Utilizing the Global Burden of Disease Study 2021 framework, we meticulously estimated the prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLL) attributable to HHD, stratified by age, sex, year, and location across the US from 1990 to 2021.

Results: From 1990 to 2021, the total percentage of change (TPC) in prevalence counts, deaths, and DALYs increased by 191%, 186%, and 171% respectively. Age-standardized rates also rose, with a 62% increase in prevalence (ASPR), 53% in mortality (ASMR), and 57% in DALYs rate (ASDALR). The highest TPC in ASPR was observed in Oklahoma, with a 136% increase, while the lowest was in the District of Columbia at 25%. Regarding ASMR, the highest increase was observed in Oklahoma by 503%, followed by Arkansas at 218%. The highest number of deaths occurred in the 90-94 age group (10,183), with the highest prevalence in the 70-74 age group (145,046) and YLDs in the same age group (11,597). In terms of gender, males experienced higher increases compared to females across all parameters, with prevalence (231% vs. 162%), deaths (212% vs. 168%), and YLDs (222% vs. 154%) from 1990 to 2021.

Conclusion: Deaths due to HHD accounted for 7.58% of all Cardiovascular related deaths in 2021 in the US. emphasizing the urgent need for targeted interventions. Policymakers and stakeholders should prioritize reducing HHD burden through comprehensive public health campaigns, promoting healthy lifestyles, improving healthcare access, and implementing evidence-based interventions. Collaboration among healthcare providers, policymakers, and community organizations is crucial for sustainable solutions to reduce HHD's prevalence and impact on population health.