Nation & World

Hypertension costly to patients, society

Blood pressure readings fall into four general categories, ranging from normal to stage 2 high blood pressure. (Dreamstime/TNS)
Blood pressure readings fall into four general categories, ranging from normal to stage 2 high blood pressure. (Dreamstime/TNS)

(Reuters Health) — Each year, U.S. adults with high blood pressure incur almost $2,000 more in annual health care costs, according to a new study

“The increased cost burden of hypertension may cause some patients to discontinue antihypertensive medication,” especially if they don’t have insurance coverage for prescription drugs, Dr. Robert M. Carey of the University of Virginia School of Medicine, who was not involved in the study, said by email.

Nationally, health care for adults with high blood pressure, or hypertension, costs an extra $131 billion per year, according to Dr. Elizabeth B. Kirkland of the Medical University of South Carolina in Charleston and colleagues.

Kirkland’s team used data from the Medical Expenditure Panel Survey to analyze 12 years of medical expenditures for nearly 225,000 adults, about a third of whom had hypertension.

From 2003 to 2014, compared to adults without hypertension, those with the condition averaged $1,920 more in annual health care costs, the researchers reported in the Journal of the American Heart Association.

People with hypertension had two-and-a-half times the inpatient costs, nearly double the outpatient costs, and nearly triple the prescription medication costs of their peers without high blood pressure.

The researchers did not analyze what part of these costs was paid by insurance and what part patients paid directly out of pocket.

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Kirkland told Reuters Health by email that expenditures associated with hypertension seem to be shifting from inpatient to outpatient settings.

“This may indicate that with progressively better control of hypertension over time, we are beginning to see a reduction in the (complications) resulting from uncontrolled blood pressure,” Carey said.

In patients with hypertension, the force of blood pushing against the blood vessels is too high. Over time, this sustained pressure damages the arteries and heart and leads to other serious health concerns.

High blood pressure often has no symptoms. As a result, patients might delay or skip treatment, said Dr. Paul Heidenreich of Stanford University School of Medicine in California, who was not involved with the study.

“The consequences are long-term, leading to more heart disease, stroke and kidney disease,” he said in an email.

Last year, the American Heart Association, the American College of Cardiology and several other health organizations lowered the threshold for high blood pressure in adults to 130/80 millimeters of mercury. The first number, the systolic blood pressure, is the pressure blood exerts against artery walls when the heart beats. The second number, the diastolic pressure, is the pressure blood exerts on artery walls during the pauses between heartbeats. Previous guidelines had set the threshold at 140/90 mm Hg or higher.

The proportion of American adults with hypertension rose from 32 percent to 46 percent — or 103 million people — under the new guideline, according to the American Heart Association.

Kirkland’s analysis does not account for that new, lower threshold. But she says it will increase the number of people in the affected population, which in turn will likely increase the overall societal cost. On the flip side, it may lower the average per patient cost, since patients on the lower end of that range may be able to control their blood pressure with changes to diet and exercise instead of new medications.

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