Estimated annual direct expenditures in the United States as a result of inappropriate hypertension treatment according to national treatment guidelines

Clin Ther. 2009 Jul;31(7):1581-94. doi: 10.1016/j.clinthera.2009.07.010.


Background: Insufficient research about the economic impact of noncompliance with hypertension treatment guidelines has been published to date.

Objectives: The aims of this study were to estimate the following: (1) the prevalence of hypertension in the United States; (2) the proportion of US patients with hypertension who are appropriately and inappropriately treated; and (3) incremental direct expenditures for inappropriate hypertension management in the United States in 2006, from the perspective of society.

Methods: Analysis of the 2006 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was conducted. Definitions of inappropriate and appropriate hypertension treatment were taken from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Hypertensive patients were identified in the MEPS database by medical diagnosis for hypertension based on International Classification of Diseases, Ninth Revision, Clinical Modification codes (401.xx-405.xx), consumption of hypertension-related medical services, self-report of hypertension diagnosis from a physician, or prescription for an antihypertensive medication. Incremental expenditure for inappropriate hypertension management per JNC 7 guidelines was estimated through least-squares regression adjusting for age, sex, race, and education, and for comorbidities using the D'Hoore adaptation of the Charlson comorbidity index. Sample data were extrapolated to the US population and 95% confidence limits for estimates were calculated using the Taylor expansion method. All costs were reported as year-2006 US dollars.

Results: Extrapolated estimates based on the MEPS sample data indicated that 19.7% of those aged > or = 18 years in the US population had hypertension in 2006; 64% were treated appropriately and 36% were treated inappropriately. The mean per-person incremental expenditure for inappropriate treatment was $234.60 for 2006, with total incremental annual direct expenditures of $12,747,337,035 after adjusting for patient demographics and comorbidities.

Conclusions: Based on this retrospective analysis of year-2006 MEPS data, inappropriate management of hypertension contributes substantially to health care resource utilization and associated costs in the United States. The overall prevalence of hypertension was estimated at 19.7%, with 36% of identified patients treated inappropriately. The per-person cost for inappropriate treatment was $234.60, and the total national cost was approximately $13 billion.

MeSH terms

  • Adolescent
  • Adult
  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use
  • Databases, Factual
  • Female
  • Guideline Adherence*
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / economics*
  • Hypertension / epidemiology
  • Least-Squares Analysis
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / standards*
  • Prevalence
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult


  • Antihypertensive Agents