Hypertension-attributable stroke burden in younger vs older people: analysis of GBD 2021 and NHANES databases.

Background: Hypertension is a leading global cause of stroke. Cardiovascular diseases are occurring at progressively younger ages. This study aims to compare the younger and older age groups burden of stroke attributable to hypertension. Methods: Analyses were conducted using two databases: the Global Burden of Disease (GBD) study and the U.S. National Health and Nutrition Examination Survey (NHANES). For GBD study, stroke mortality attributable to hypertension was extracted. Age-period-cohort model was used to assess differences in annual mortality reduction rates across age groups. Estimated Annual Percentage Change (EAPC) was calculated to quantify the temporal trend in age-standardized mortality. Health inequalities were assessed using the concentration index. For NHANES, analyses were restricted to participants age≥25 years with hypertension. Among these participants, proportions of uncontrolled hypertension and hypertension unawareness were calculated, with sampling weights applied to ensure nationally representative estimates. Results: Hypertension was the dominant risk factor for stroke-related deaths, contributing to 50.5 % of global mortality. Age-period-cohort model revealed a key age-specific pattern: annual mortality rate reductions were slower in adults aged 25-54 years than in those aged≥55. EAPC values further confirmed this trend, with slower annual death rate declines in adults aged 25-54 years (-1.37 %) versus those aged ≥55 years (-1.74 %). NHANES data showed worse hypertension control and awareness in younger hypertensive populations: uncontrolled hypertension rose from 79.6 % (2013-2014) to 88.9 % (2021-2023) in 25-54-year-olds, while remaining relative stable (71.2-71.8 %) in older groups. Hypertension unawareness increased from 35 % to 48 % in younger adults over the same period, consistently higher than in older hypertensive populations. Concentration index indicated widening health inequalities, becoming increasingly concentrated in lower socioeconomic status countries. More importantly, this concentration trend was more pronounced among younger adults (25-54 years) than in older groups across all study years. Conclusions: Hypertension drives most stroke deaths. Younger adults experience slower mortality improvements, worse hypertension control and awareness, and more severe health inequalities compared to older adults. Therefore, age-specific interventions are urgently needed.