High blood pressure carries a price tag of $131 billion a year

By AMERICAN HEART ASSOCIATION NEWS

High blood pressure is one of the nation’s biggest health problems.

A new study quantifies just how big: The overall cost of high blood pressure has risen to about $131 billion a year – or nearly $2,000 in higher health care expenses for each patient.

That makes high blood pressure, or hypertension, costlier than other forms of heart disease, based on statistics from the American Heart Association.

The study, which was done by researchers at the Medical University of South Carolina, published Wednesday in the Journal of the American Heart Association.

“More people are being diagnosed with hypertension despite better access to health care and medical advancements,” said Dr. Elizabeth Kirkland, the study’s lead author and assistant professor of internal medicine at MUSC in Charleston. “There’s a tremendous need to be aware of this problem and the risks – costs, health outcomes, other diseases.”

It’s one of few studies to solely examine hypertension costs trends over time. Moreover, the study likely underestimated the costs because it used an older definition of hypertension.

In November, the AHA and American College of Cardiology lowered its threshold for hypertension – to 130/80 versus the previous 140/90. That means about half of all American adults, or 103 million people, have high blood pressure, compared with about one-third before.

“If we were to redo this analysis under the new definition, we would expect the cost on society to be much higher because the prevalence of high blood pressure is much higher,” Kirkland said. “Bringing younger, healthier patients into the mix may bring individual costs down, if they make treatment or lifestyle changes early. Because the impact is unclear, we didn’t feel confident estimating new costs.”

Still, the study findings point to a significant public health issue.

Hypertension is called the “silent killer” because often there are no symptoms. Nearly half of all Americans with hypertension don’t control their blood pressure even though it can lead to heart attacks, stroke and kidney disease. The number of deaths involving high blood pressure reached nearly 430,000 in 2015, according to AHA statistics.

In this new study, researchers used a large database with a sample of almost 225,000 Americans to estimate total annual health care expenses (adjusted to 2016 dollars) over 12 years.

Hospital inpatient and outpatient costs accounted for the largest portions of total hypertension-related spending. While outpatient, emergency room visit and home health care costs rose, annual prescription medication costs declined slightly.

Although the overall cost of hypertension rose, the study found that individual expenses remained stable over time. Patient spending, however, shifted from inpatient to more outpatient, perhaps due to better patient access to preventive and outpatient care under the 2010 Affordable Care Act, Kirkland said.

“A reduction in inpatient costs is good,” said cardiovascular endocrinologist Dr. Robert M. Carey, vice chairman of the committee that wrote the 2017 AHA/ACC blood pressure guidelines and dean emeritus of the University of Virginia School of Medicine.

“It may mean we’re getting a better handle on blood pressure control and preventing comorbidities that demand hospitalization, such as congestive heart failure and myocardial infarction,” said Carey, who was not involved in the new study.

The study excluded institutionalized and military patients, which may have underestimated total costs, and didn’t evaluate the severity of hypertension. Those weaknesses, however, are minor given the robust and large database, Kirkland said.

The researchers conclude that an emphasis on high blood pressure prevention through control of risk factors – ultimately preventing complications and hospital visits from uncontrolled high blood pressure – may be the best medicine.

They also recommend telemonitoring as a way to make care more accessible, affordable and effective. Patients at home could check their blood pressure and consult with a doctor by video or wear a 24-hour monitor that collects blood pressure data to be evaluated by a medical professional.

Kirkland already is studying telemonitoring and remote management of hypertension in rural, low-income and minority populations.

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