ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Global Burden of Deaths and Disability from Atrial Fibrillation and Flutter Attributable to High Systolic Blood Pressure: GBD 2021 Analysis with Projections to 2035
Guoqian Ma 1
Yuan Li 2
Fan Jia 1
1. Department of Cardiology, Yan’an Hospital, Kunming Medical University, Kunming, China
2. Ultrasound Department, Kunming Maternal and Child Health Hospital, Kunming, China, kunming, China
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Abstract
Background Atrial fibrillation and flutter (AF/AFL) represent a rapidly growing global public health challenge, with rising prevalence and associated morbidity and mortality. High systolic blood pressure (HSBP) is a leading modifiable risk factor for AF/AFL. Comprehensive, up-to-date global estimates of AF/AFL burden attributable to HSBP, including future projections, remain limited. Methods We used data from the Global Burden of Disease Study 2021 (GBD 2021) to systematically estimate the mortality and disability-adjusted life years (DALYs) of AF/AFL attributable to HSBP from 1990 to 2021 across 204 countries and territories. Burden was analyzed by age, sex, region, and sociodemographic index (SDI). Bayesian age–period–cohort modeling was employed to project trends in mortality and DALYs to 2035. Findings Globally, AF/AFL deaths attributable to HSBP increased from 36,854 (95% UI 13,821– 58,446) in 1990 to 103,423 (95% UI 36,820 –170,727) in 2021. The global death rate remained relatively stable (1.36 to 1.33 per 100,000; EAPC –0.11%, 95% CI –0.16 to –0.07). DALYs attributable to HSBP rose from 1,049,327 (95% UI 362,165–1,717,378) to 2,514,582 (95% UI 849,855–4,226,734), while DALY rate declined slightly (31.77 to 30.53 per 100,000; EAPC –0.20%, 95% CI –0.23% to –0.17%). Substantial regional disparities were observed, with the highest burdens in high-SDI regions and rapid increases in middle-and low-SDI regions. Projections indicate a continued rise in absolute AF/AFL deaths and DALYs attributable to HSBP by 2035, despite modest declines in age-standardized rates. Interpretation The global burden of AF/AFL attributable to HSBP remains substantial and is projected to rise further, particularly in low-and middle-SDI regions. Intensified efforts to control HSBP and address other modifiable risk factors are urgently needed to reduce the future AF/AFL burden.
Summary
Keywords
Atrial Fibrillation / Flutter, BAPC model, GBD 2021 data, High systolic blood pressure (HSBP), Mortality
Received
22 June 2025
Accepted
04 February 2026
Copyright
© 2026 Ma, Li and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fan Jia
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