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 AND 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% CI -5.29 to -4.76, 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.