{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T22:43:11Z","timestamp":1792881791958,"version":"4.5.0"},"reference-count":45,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,5]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the global and regional trends in disparities of high systolic blood pressure (HSBP) burden between 1990 and 2021 by age, sex, sociodemographic index and health systems\u2019 performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Global population-level data were extracted from the Global Burden of Disease (GBD) 2021 study covering all countries, grouped by World Bank income classifications and seven GBD super-regions. Health system performance was assessed using Healthcare Access and Quality Index categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Population-level estimates including all age groups and sexes from 1990 to 2021 as captured in the GBD 2021 dataset were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Age-standardised rates and counts of disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and deaths attributable to HSBP, with 95% uncertainty intervals (UIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2021, the global number of DALYs, YLLs, YLDs and deaths related to HSBP increased for both sexes, with men experiencing a higher frequency. The global number of DALYs rose by 58.4% (95% UI: 48.1%, 69.9%), reaching 226\u2009million (95% UI: 190, 259) in 2021, while deaths increased by 65.3% (95% UI: 54.2%, 77.3%), totalling 11\u2009million (95% UI: 9, 13). Despite these increases, age-standardised rates of DALYs, deaths, YLDs and YLLs declined worldwide, with more significant decreases observed in women. Low-income and lower-middle-income countries, according to World Bank classification, faced the highest burden of HSBP in terms of DALY and death rates, whereas high-income countries reported the greatest reductions. The burden of HSBP also exhibited considerable variation by age, sex and income level, with older age groups bearing the heaviest burden. Regions with advanced health systems demonstrated significant declines in HSBP burden, while areas with minimal health systems experienced stable or slight decreases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The burden associated with HSBP varied across age, sex, income levels, location and health system quality. Interventions should be tailored to these variations to mitigate this burden and address demographic disparities, socioeconomic factors and healthcare system differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104107","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T01:45:27Z","timestamp":1756086327000},"page":"e104107","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Age, sex, income, sociodemographic and health system inequalities in the global burden of high systolic blood pressure: an analysis of the Global Burden of Disease Study 2021"],"prefix":"10.1136","volume":"15","author":[{"given":"Azin","family":"Kadkhodamanesh","sequence":"first","affiliation":[{"name":"HIV\/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 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