Objective To analyze the trends and risk factors of hypertensive heart disease (HHD) burden in BRICS countries from 1990 to 2021, providing data support and policy basis for prevention and control of HHD in China and strengthening health cooperation among BRICS countries.

Methods The trends in prevalence, mortality and disability adjusted life years (DALYs) rates of HHD in the BRICS countries (Brazil, Russia, India, China and South Africa) from 1990 to 2021 were analyzed using the Global Burden of Disease 2021 Database (GBD2021), and the temporal changes in the age distribution of deaths were simulated. The Joinpoint regression model was used to analyze the average annual percentage change (AAPC) of disease burden. The trends in major risk factors for HHD mortality were assessed according to the GBD database. In addition, the contribution of different factors to changes in HHD burden was identified and quantified through decomposition analysis and the trend of HHD burden in China from 2022 to 2035 was predicted using the Bayesian age-period-cohort (BAPC) model.

Results In 2021, the burden of HHD in BRICS countries increased with age, accelerated sharply among people over 65 years old, with gender differences existing. From 1990 to 2021, the standardized DALYs rate and standardized mortality rate of HHD in Brazil, India and China showed a steady downward trend, while which showed an initial increase followed by a decrease in Russia and South Africa, and the AAPC of standardized DALYs rate and standardized mortality rate in China were −13.89 and −0.79 respectively (P<0.05), with the largest decline. Meanwhile, the mortality rate of the elderly aged over 65 in the BRICS countries had significantly increased, with China having the highest rate, followed by Brazil, Russia and India, and South Africa remained relatively stable. Risk factor analysis indicated that high systolic blood pressure (SBP),body mass index (BMI),high salt diet,and alcohol use had become the top 4 risk factors affecting HHD death. The decomposition analysis also found that aging was an important factor affecting the HHD death in BRICS countries, which was the largest proportion in the burden of HHD in China, with a contribution percentage of 250.85%; BAPC model predicted a downward trend in the burden of HHD in China from 2022 to 2035.

Conclusion This study reveals the temporal and spatial trends of HHD burden and major risk factors in BRICS countries, and finds that high SBP,BMI,high salt diet and alcohol are also important factors affecting HHD. The results provide a scientific basis for BRICS countries to formulate targeted public health policies.