Divergent Trends in Stroke Subtype Mortality Attributable to High Systolic Blood Pressure in China, 1990 to 2021: An Age-Period-Cohort Analysis and Projection

Background:High systolic blood pressure (HSBP) is a major contributor to stroke mortality in China.This study analyzed trends in HSBP-attributable stroke mortality from 1990 to 2021 to elucidate the effects of age, period, and cohort and to project future trends for precision prevention. Material/Methods:Using Global Burden of Disease 2021 estimates, temporal trends in age-standardized mortality rates were assessed by Joinpoint regression, age-period-cohort (APC) patterns were evaluated using APC modeling, and mortality trends were projected to 2030 within a Bayesian APC framework incorporating United Nations population projections.Uncertainty was summarized via 95% credible intervals. Results:From 1990 to 2021, HSBP-attributable stroke mortality declined overall (average annual percentage change [AAPC] -1.31%, 95% confidence interval [CI] -1.52 to -1.10), with pronounced subtype heterogeneity: ischemic stroke (IS) was relatively stable (AAPC -0.03%, 95% CI -0.29 to 0.24), whereas intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) substantially declined (AAPC -1.75%, 95% CI -1.97 to -1.52; and -5.03%, 95% respectively).IS trends diverged by sex, declining in women but increasing in men; mortality steeply increased according to age, with pronounced acceleration after 75 years.Cohort patterns suggested elevated risk in more recent birth cohorts. Conclusions:Our analyses show that HSBP-attributable stroke mortality in China generally declined over the past 3 decades, but trends noticeably diverged among subtypes (ICH substantially declined and SAH most rapidly decreased, whereas IS remained relatively stable), underscoring the need for subtype-and population-specific prevention priorities, including sustained population-wide sodium reduction.