May 30, 2018
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Health care expenditures elevated in patients with hypertension

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Patients with hypertension had an estimated $2,000 higher annual health care expenditure compared with those without hypertension, according to a study published in the Journal of the American Heart Association.

The new lower definition of high blood pressure will increase the number of adults in the hypertensive population,” Elizabeth B. Kirkland, MD, MSCR, assistant professor of internal medicine at Medical University of South Carolina in Charleston, said in a press release. “This may decrease the average cost of hypertension for individual patients while increasing the overall societal costs of hypertension.”

Researchers analyzed data from 224,920 patients from the Medical Expenditure Panel Survey-Household Components from 2003 to 2014, which included self-reported estimates of expenditures, health care use, health insurance coverage and source of coverage. This information was validated by data on financial and medical characteristics from physicians, hospitals, pharmacies and home health care providers.

The dependent variable of interest was total health care expenditure, and the primary independent variable of interest was hypertension. The diagnosis of hypertension was self-reported.

Of the patients in the study, 36.9% had hypertension. During a 12-year period, the unadjusted mean annual medical expenditure for patients with hypertension was $9,089 (95% CI, 8,900-9,278).

Compared with patients without hypertension, those with hypertension had an adjusted incremental expenditure of $1,920 (95% CI, 1,724-2,117). Patients with hypertension also had an estimated 2.5 times the inpatient cost, nearly triple the prescription medication expenditure and nearly twice the outpatient cost.

During the study period, the estimated annual incremental cost for the patients with hypertension in the U.S. was $131 billion higher compared with those without hypertension.

“This may reflect the expansion of preventative care services for millions of Americans under the Affordable Care Act,” Kirkland and colleagues wrote. “As overall U.S. health care costs continue to rise, it is imperative that we identify effective strategies to improve control of chronic diseases that are associated with high annual expenditures. For hypertension, these efforts may focus on expanded access to preventative care services and continued innovation for non-office-based care delivery such as telemonitoring of home measurements and 24-hour ambulatory BP monitoring.”

In a related commentary, Joey Granger, PhD, FAHA, Billy S. Guyton Distinguished Professor, professor of physiology and medicine and director of the Cardiovascular-Renal Research Center at University of Mississippi Medical Center in Jackson and chair of the American Heart Association Council on Hypertension, wrote: “Access to care is one of many influences on the development and management of high blood pressure. Other complex, interrelated factors include social support and characteristics of the residential or built environment that influence individuals’ health behaviors. Social and economic disadvantages also affect health behaviors and contribute to increased cardiovascular risk among lower-income populations and racial/ethnic minorities.” – by Darlene Dobkowski

Disclosures: The authors and Granger report no relevant financial disclosures.