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.