Paradoxical Trends in Hypertensive Heart Disease: Rising Burden in High-Sociodemographic-Index Regions Despite Healthcare Quality-An Age-Period-Cohort Analysis, 1992-2021.

Hypertensive heart disease (HHD) is a major global cause of cardiovascular mortality and disability-adjusted life years (DALYs). We used an age-period-cohort model to assess mortality and DALY trends (1992-2021) across sociodemographic regions and their association with healthcare quality. Using Global Burden of Disease (GBD) data (1992-2021), we applied an age-period-cohort model to HHD mortality and DALYs in adults aged 20-54 across SDI regions and examined associations with healthcare quality. HHD mortality and DALYs declined across most SDI regions over 29 years, with high-middle SDI females showing the greatest reductions (ASMR: -3.2% annually; ASDR: -2.9%). Conversely, high-SDI regions exhibited rises of ~1.7% and ~1.2% in males and females, respectively. Low-SDI regions maintained the highest absolute burden, with 2021 mortality rates 10-fold higher in males and 13.7-fold higher in females versus high-SDI regions, despite the steepest declines. The male-to-female mortality ratio ranged from 1.74× (high-middle SDI) to 1.14× (low SDI). Age-related patterns diverged markedly: high-SDI females showed a 46.7% risk decline for ages 20-54, while males experienced a 92-111% lifespan risk increase. Period effects showed pre-2002 peak risk in lower-SDI versus post-2002 increases in high-SDI regions (males: +36%; females: +24%). The 1997-2001 birth cohort in high-SDI regions showed the highest risk (males: RR 1.75-1.85; females: RR 1.45-1.50). No significant correlation was found between HHD burden and HAQI (ASMR: r = 0.40; ASDR: r = 0.42; p > 0.05). HHD remains a major global health concern, with rising burden in high-SDI regions and persistent male predominance. Healthcare quality alone is insufficient, highlighting the need for targeted prevention focused on modifiable risk factors in working-age adults.