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Changing patterns of the burden for atrial fibrillation/atrial flutter attributable to high systolic blood pressure in China from 1990 to 2021

Hypertension Research (2025)Cite this article

Abstract

This study aims to investigate the changing patterns of the burden for atrial fibrillation (AF)/atrial flutter (AFL) attributed to high systolic blood pressure (SBP) in China. Data were sourced from the Global Burden of Disease (GBD) 2021 project. The disease burden of AF/AFL attributed to high SBP in China from 1990 to 2021 was analyzed stratified by sex and age, along with the trend prediction from 2022 to 2050. In China, between 1990 and 2021, the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life years (DALYs) rate (ASDR) of AF/AFL attributable to high SBP in male have been increasing, and the trend will continue till 2050, whereas in female, the trend is slightly downward. Globally, however, the disease burden according to the estimated annual percentage changes (EAPC) of ASMR and ASDR presents a decreasing trend in both genders between 1990 and 2021. The main driver of the increased DALY burden for AF/AFL attributed to high SBP is population aging. In China, the disease burden of AF/AFL attributable to high SBP in male has been increasing between 1990 and 2021 and keeps an upward trend till 2050, whereas in female, the trend is slightly downward. Our research implies that the public health decision-making needs to give sufficient attention to alleviate the burden of AF /AFL attributable to high SBP in China by promoting awareness, treatment, and controlling rates of hypertension, especially in male.

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Data availability

The datasets generated and analyzed in the current study are available at GBD 2021 website: https://ghdx.healthdata.org/gbd-results-tool.

References

  1. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns H, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;https://doi.org/10.1093/eurheartj/ehae176.

  2. GBD 2017 Population and Fertility CollaboratorsPopulation and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1995–2051.

    Article  Google Scholar 

  3. Shi S, Tang Y, Zhao Q, Yan H, Yu B, Zheng Q, et al. Prevalence and risk of atrial fibrillation in China: a national cross-sectional epidemiological study. Lancet Reg Health West Pac. 2022;23:100439.

    PubMed  PubMed Central  Google Scholar 

  4. Nazarzadeh M, Pinho-Gomes AC, Bidel Z, Canoy D, Dehghan A, Smith Byrne K, et al. Genetic susceptibility, elevated blood pressure, and risk of atrial fibrillation: a Mendelian randomization study. Genome Med. 2021;13:38.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Li Y, Wang DD, Ley SH, Howard AG, He Y, Lu Y, et al. Potential impact of time trend of lifestyle factors on cardiovascular disease burden in China. J Am Coll Cardiol. 2016;68:818–33.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Li YG, Pastori D, Farcomeni A, Yang PS, Jang E, Joung B, et al. A simple clinical risk score (C(2)HEST) for predicting incident atrial fibrillation in asian subjects: derivation in 471,446 chinese subjects, with internal validation and external application in 451,199 Korean subjects. Chest. 2019;155:510–8.

    Article  PubMed  Google Scholar 

  7. Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, et al. Status of hypertension in China: Results from the China Hypertension Survey, 2012-2015. Circulation. 2018;137:2344–56.

    Article  PubMed  Google Scholar 

  8. Nie Z, Xu H, Chen C, Gan Y, Chen G, Wang C, et al. Population attributable risks of potential modifiable factors for atrial fibrillation in China: a National Survey. Risk Manag Health Policy. 2022;15:1215–24.

    Article  Google Scholar 

  9. Diseases GBD, Injuries C. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2133–61.

    Article  Google Scholar 

  10. Brauer M, Roth GA, Aravkin AY, Zheng P, Abate KH, Abate YH, et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2162–203.

    Article  Google Scholar 

  11. Hankey BF, Ries LA, Kosary CL, Feuer EJ, Merrill RM, Clegg LX, et al. Partitioning linear trends in age-adjusted rates. Cancer Causes Control. 2000;11:31–5.

    PubMed  CAS  Google Scholar 

  12. GBD 2019 Dementia Forecasting CollaboratorsEstimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7:e105–e25.

    Article  Google Scholar 

  13. Das Gupta P. A general method of decomposing a difference between two rates into several components. Demography. 1978;15:99–112.

    Article  PubMed  Google Scholar 

  14. Clayton D, Schifflers E. Models for temporal variation in cancer rates. II: age-period-cohort models. Stat Med. 1987;6:469–81.

    Article  PubMed  CAS  Google Scholar 

  15. Wang Y, Wang J, Chen S, Li B, Lu X, Li J. Different changing patterns for stroke subtype mortality attributable to high sodium intake in China during 1990 to 2019. Stroke. 2023;54:1078–87.

    Article  PubMed  CAS  Google Scholar 

  16. Rosenberg PS, Check DP, Anderson WF. A web tool for age-period-cohort analysis of cancer incidence and mortality rates. Cancer Epidemiol Biomark Prev. 2014;23:2296–302.

    Article  Google Scholar 

  17. Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392:2052–90.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Soliman EZ, Rahman AF, Zhang ZM, Rodriguez CJ, Chang TI, Bates JT, et al. Effect of intensive blood pressure lowering on the risk of atrial fibrillation. Hypertension. 2020;75:1491–6.

    Article  PubMed  CAS  Google Scholar 

  19. Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation: doubts and certainties from basic and clinical studies. Circ Res. 2018;122:352–68.

    Article  PubMed  CAS  Google Scholar 

  20. Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H, et al. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens. 2003;21:707–16.

    Article  PubMed  CAS  Google Scholar 

  21. Du S, Wang H, Zhang B, Popkin BM. Dietary potassium intake remains low and sodium intake remains high, and most sodium is derived from home food preparation for chinese adults, 1991–2015 trends. J Nutr. 2020;150:1230–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C, et al. Prevalence, awareness, treatment, and control of hypertension in China, 2004–18: findings from six rounds of a national survey. BMJ. 2023;380:e071952.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ma S, Yang L, Zhao M, Magnussen CG, Xi B. Trends in hypertension prevalence, awareness, treatment and control rates among Chinese adults, 1991–2015. J Hypertens. 2021;39:740–8.

    Article  PubMed  CAS  Google Scholar 

  24. Kawabe H, Azegami T, Takeda A, Kanda T, Saito I, Saruta T, et al. Features of and preventive measures against hypertension in the young. Hypertens Res. 2019;42:935–48.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yin R, Yin L, Li L, Silva-Nash J, Tan J, Pan Z, et al. Hypertension in China: burdens, guidelines and policy responses: a state-of-the-art review. J Hum Hypertens. 2022;36:126–34.

    Article  PubMed  Google Scholar 

  26. Westerman S, Wenger N. Gender differences in atrial fibrillation: a review of epidemiology, management, and outcomes. Curr Cardiol Rev. 2019;15:136–44.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Colafella KMM, Denton KM. Sex-specific differences in hypertension and associated cardiovascular disease. Nat Rev Nephrol. 2018;14:185–201.

    Article  PubMed  Google Scholar 

  28. Kim JS, Shin SY, Kang JH, Yong HS, Na JO, Choi CU, et al. Influence of sex on the association between epicardial adipose tissue and left atrial transport function in patients with atrial fibrillation: a multislice computed tomography study. J Am Heart Assoc. 2017;6:e006077.

  29. Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011;342:d124.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nielsen PB, Brondum RF, Nohr AK, Overvad TF, Lip GYH. Risk of stroke in male and female patients with atrial fibrillation in a nationwide cohort. Nat Commun. 2024;15:6728.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Zhao QY, Shi SB, Huang H, Jiang H, Yang B, Wu G, et al. Contemporary characteristics, management, and outcomes of patients hospitalized for atrial fibrillation in China: results from the real-world study of Chinese atrial fibrillation registry. Chin Med J. 2020;133:2883–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Gu HQ, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, et al. Assessment of trends in guideline-based oral anticoagulant prescription for patients with ischemic stroke and atrial fibrillation in China. JAMA Netw Open. 2021;4:e2118816.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wang JR, Du X, Dong JZ, Chang SS, Jiang C, Sang CH, et al. Use of oral anticoagulants and its associated factors among nonvalvular atrial fibrillation patients with new-onset acute ischemic stroke: a report from the China Atrial Fibrillation Registry study. Clin Cardiol. 2022;45:60–7.

    Article  PubMed  Google Scholar 

  34. Dong XJ, Wang BB, Hou FF, Jiao Y, Li HW, Lv SP, et al. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2019. Europace. 2023;25:793–803.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dagres N, Nieuwlaat R, Vardas PE, Andresen D, Levy S, Cobbe S, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol. 2007;49:572–7.

    Article  PubMed  Google Scholar 

  36. Tian XT, Xu YJ, Yang YQ. Gender differences in arrhythmias: focused on atrial fibrillation. J Cardiovasc Transl Res. 2020;13:85–96.

    Article  PubMed  Google Scholar 

  37. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386:154–62.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gao P, Gao X, Xie B, Tse G, Liu T. Aging and atrial fibrillation: a vicious circle. Int J Cardiol. 2024;395:131445.

    Article  PubMed  Google Scholar 

  39. Hu FB, Liu Y, Willett WC. Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obes Rev. 2011;12:552–9.

    Article  PubMed  CAS  Google Scholar 

  40. He Y, Li Y, Yang X, Hemler EC, Fang Y, Zhao L, et al. The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982–2012: a cross-sectional population-based study. Lancet Diab Endocrinol. 2019;7:540–8.

    Article  Google Scholar 

  41. Hipgrave DB, Chang S, Li X, Wu Y. Salt and sodium intake in China. JAMA. 2016;315:703–5.

    Article  PubMed  Google Scholar 

  42. Noh B, McCullough LD, Moruno-Manchon JF. Sex-biased autophagy as a potential mechanism mediating sex differences in ischemic stroke outcome. Neural Regen Res. 2023;18:31–7.

    Article  PubMed  CAS  Google Scholar 

  43. Ramirez LA, Sullivan JC. Sex differences in hypertension: where we have been and where we are going. Am J Hypertens. 2018;31:1247–54.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Loo G, Puar T, Foo R, Ong TK, Wang TD, Nguyen QN, et al. Unique characteristics of Asians with hypertension: what is known and what can be done?. J Hypertens. 2024;42:1482–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Acknowledgements

We extend our sincere thanks to the contributors of the GBD 2021 and the Institute for Health Metrics and Evaluation (IHME) for their invaluable work. The study funders did not participate in the study’s design, data collection, analysis, interpretation, or report writing.

Funding

This study was supported by the National Natural Science Foundation of China [grant number: 82170247] and the Key Research Center Construction Project of Shanghai(2022ZZ01008).

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  1. These authors contributed equally: Bin Liu, Jian Wang.

Authors and Affiliations

  1. Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, China

    Bin Liu

  2. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    Jian Wang, Shuai Yu, Yashu Kuang, Ben He, Jing Xu & Lisheng Jiang

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  1. Bin Liu
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  7. Lisheng Jiang
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Contributions

JL and XJ designed the study. LB and WJ analyzed the data, performed statistical analyses, and drafted the initial manuscript. JL and XJ checked and corrected the statistical analyses. YS, KYS, and HB modified the initial manuscript. All authors reviewed the drafted manuscript for critical content and approved the final version of the manuscript. The corresponding authors (JL and XJ) attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Jing Xu or Lisheng Jiang.

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Liu, B., Wang, J., Yu, S. et al. Changing patterns of the burden for atrial fibrillation/atrial flutter attributable to high systolic blood pressure in China from 1990 to 2021. Hypertens Res (2025). https://doi.org/10.1038/s41440-025-02448-w

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