This study aimed to examine global hypertensive heart disease (HHD) trends (1990–2019). Methods: We extracted data from the Global Burden of Disease (GBD) 2019 Study, encompassing 204 countries and territories. We analyzed the age-adjusted mortality rates (AAMRs), crude mortality, prevalence, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY). Joinpoint Regression Analysis was used to calculate the Annual Percentage Change (APC), with p < 0.05 indicating statistical significance. Results were stratified by region, Socio-Demographic Index (SDI), and gender. Results: Globally, the crude mortality rate for HHD rose from 12.2 (95% UI 9.9–13.6) to 14.9 (95% UI 16.5–11.1) deaths/100,000 population (1990–2019), whereas the AAMR declined from 19.3 (95% UI 5.8–21.6) to 15.1 (95% UI 11.1–16.7). A Joinpoint Analysis revealed significant APC shifts: a decrease of −1.53% (p < 0.05) from 1990 to 2006, an increase of +0.60% (p < 0.05) from 2006 to 2015, and a subsequent decrease of −1.28% (p < 0.05) from 2006 to 2019. Eastern Europe showed the highest annual rate of change in AAMR at 0.9 (95% UI: −0.1 to 1.2), whereas the high-income Asia Pacific region experienced the largest decline at −0.66 (95% UI −0.27–−0.72). Central Asian males had an AAMR of 31.1 (95% UI 35.3–22.9) in 2019, and Sub-Saharan African females reached 38.5 (95% UI 48.4–26.3). YLL trended downward in both sexes (APC: −1.94, p < 0.05 in males; −1.81, p < 0.05 in females), yet YLD rose steadily in recent years, underscoring a growing chronic burden. The AAMR was highest in 2019 among Sub-Saharan African females, which is a particularly important area. Conclusions: Targeted strategies are essential to mitigate the escalating HHD burden.