Background and purpose <p>Stroke is a major global cause of death, disability, and socioeconomic burden. This study analyzed long-term trends in burden of stroke attributable to high systolic blood pressure (HSBP), to evaluate the effect of HSBP control in stroke prevention.</p> Methods <p>The Global Burden of Disease (GBD) 2021 database was utilized. Crude and age-standardized incidence, prevalence, mortality, and disability-adjusted life-year (DALY) rates were employed as disease burden indicators. The Global and Different Socio-demographic Index (SDI) region trends in stroke burden were analyzed using Joinpoint analysis. Subgroup analyses were conducted by gender and age.</p> Results <p>The age-standardized incidence rate (AAPC=-0.81, 95%CI:-0.86 to -0.75), mortality rate (AAPC=-1.60, 95%CI: -1.77 to -1.43), prevalence rate (AAPC= -0.29, 95%CI: -0.30 to -0.28), and DALY rate (AAPC=-1.57, 95%CI:-1.67 to -1.47) exhibited a consistent downward trend from 1990 to 2021, but the absolute burden of stroke increased, especially in China. HSBP as the leading risk factor for stroke-related DALYs globally, accounting for 58.08% of stroke deaths and 57.25% of DALYs in 2021. Regional disparities were evident, lower SDI regions face disproportionate burden versus higher SDI regions Men exhibited higher HSBP-related stroke burden than women.</p> Conclusions <p>Despite global improvements in hypertension management and a concomitant decline in HSBP-related stroke burden, disparities persist across SDI regions. Targeted interventions, including improved access to affordable antihypertensive medications, public health education, and lifestyle modifications, are crucial to reducing the burden of stroke.</p>