Hypertension is a leading preventable risk factor for cardiovascular disease and imposes a significant public health burden worldwide.1 Epidemiological data indicate a twofold increase in the prevalence of hypertension among adults aged 30–79 years from 1990 to 2019, culminating in over one billion cases by 2019.2 Inadequately managed hypertension escalates the risk for hypertensive heart disease (HHD), which manifests through both microscopic and macroscopic changes in cardiac structure and function, as well as adaptations in the arterial system.3 The progression of HHD is further exacerbated by interconnected pathogenic mechanisms including immune activation, enhanced oxidative stress, and endothelial dysfunction. These factors collectively precipitate ventricular systolic and diastolic dysfunction, ultimately leading to heart failure.3, 4

The global demographic landscape has witnessed a significant surge in the aging population. In 1990, individuals over 60 years constituted 9.2 % of the global populace, a proportion that rose to 11.7 % by 2013, with projections estimating an increase to 21.1 % by 2050.6 This demographic shift is critical in the context of hypertensive heart disease (HHD), an ailment predominantly affecting the elderly, thereby anticipating a rising impact on this age group.7

In 2017, HHD affected an estimated 17.1 million people worldwide, resulting in approximately 925,675 deaths.5 Consequently, HHD represents a significant public health issue globally. Enhancing public awareness and improving management strategies for HHD, particularly among susceptible populations, has become an urgent international imperative.

Despite these alarming statistics, the specific trends, and burden of HHD at the individual level remain inadequately explored. Gaining insight into these trends is crucial for devising effective prevention and intervention strategies. Therefore, the primary goal of this study is to conduct an in-depth examination of the mortality and prevalence rates of hypertensive heart disease in the United States from 1990 to 2019.