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Hypertension Care-Cascade Gaps and Stroke Burden From High Systolic Blood Pressure
Xiaobin Fang1, Pingting Huang1, Ling Zheng1
1Department of Anesthesiology/Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, School of Medicine, Fuzhou University, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, China, 350001.
Aims:
Stroke remains a major global health challenge, with high systolic blood pressure (HSBP) a leading modifiable contributor. The hypertension care-cascade gap most strongly associated with HSBP-attributable stroke burden across countries remains unclear.
Methods:
This country-level ecological study used NCD Risk Factor Collaboration hypertension care-cascade estimates, Global Burden of Disease 2023 HSBP-attributable stroke estimates, and Socio-demographic Index (SDI) data, 1990-2019, including 199 countries/territories and 5970 country-years. Indicators were diagnosis, treatment, blood pressure control, and cumulative gaps; outcomes were HSBP-attributable stroke disability-adjusted life-year (DALY) and stroke death rates. Analyses included correlations, country-year models, sex-age-stratified models, exploratory 10-year age-shifted models, and 2019 country typology.
Results:
By 2019, 80.2% of people with hypertension lacked blood pressure control. The blood pressure control gap aligned most clearly with HSBP-attributable stroke burden; each 10-percentage-point higher gap was associated with a 49.1% higher stroke DALY rate (95% CI 38.5-60.5) and a 47.7% higher stroke death rate (37.9-58.2), exceeding other gaps. Associations were consistent across sex-age strata. Priority analyses identified low-SDI older men as high-gap/high-burden strata, while exploratory age-shifted analyses showed the strongest aggregate associations in men aged 30-44 years and women aged 35-44 years at the index year.
Conclusion:
The control gap showed the strongest country-level alignment with HSBP-attributable stroke burden, with high-gap/high-burden patterns concentrated among older men in low-SDI settings. Exploratory age-shifted patterns in younger adults warrant further study. These findings highlight the potential value of the control gap for population-level surveillance and comparative assessment.
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