Academy of Medical Sciences of I.R. Iran Archives of Iranian Medicine 1029-2977 29 2 2026 02 01 Global, Regional, and National Burden of Stroke Attributable to High Systolic Blood Pressure in Adults Aged 45 Years and Above From 1990 to 2021, with Projections to 2045: A Systematic and Comprehensive Analysis of the Global Burden of Disease Study 2021 98 111 10.34172/aim.34957 EN Qian Yu https://orcid.org/0009-0009-9099-2501 Yuan Tian https://orcid.org/0009-0007-3105-8140 Shuang Shen Yi Yan Xin Liu https://orcid.org/0000-0002-5081-7479 Zhining Liu https://orcid.org/0000-0002-2723-5999 Journal Article 10.34172/aim.34957 2025 08 12 2026 01 28 Introduction: Stroke remains a leading cause of death and disability worldwide, with high systolic blood pressure (HSBP) being a major modifiable risk factor. This study aimed to assess global trends, age- and SDI-specific patterns, and future projections of the stroke burden attributable to HSBP among adults aged≥45 years from 1990 to 2021. Methods: Data were obtained from the Global Burden of Disease Study 2021. Mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) were analyzed across sex, age, and socio-demographic index (SDI) strata. Estimated annual percentage change (EAPC) was used to quantify temporal trends, and the ARIMA model was applied for projections to 2045. Results: In 2021, global HSBP-attributable stroke deaths and DALYs among adults aged≥45 years reached 4.12 million and 86.18 million, respectively. From 1990 to 2021, the number of deaths increased by 51.5% and DALYs by 47.9%, despite declines in ASMR (EAPC=−1.72) and ASDR (EAPC=−1.61). Mortality and DALY rates increased with age in all SDI regions, peaking at 70–79 years, with low-SDI regions showing the highest rates and an earlier peak age. High-SDI regions recorded the lowest burden and largest declines in ASMR and ASDR. Projections indicate a continued global decline in mortality rates through 2045, with a faster reduction in females. Conclusion: Although the global age-standardized burden of HSBP-attributable stroke has declined, absolute cases continue to rise, especially among older adults and in low-SDI regions, highlighting the need for targeted prevention.