Financial and Health Costs of Uncontrolled Blood Pressure in the United Kingdom

Background: Uncontrolled hypertension is associated with an elevated risk of all cardiovascular disease, especially stroke. However, many patients with hypertension do not achieve agreed targets for blood pressure.

Objective: To estimate the cost and morbidity consequences of uncontrolled hypertension in the UK.

Design: Descriptive epidemiological study.

Methods: The study used a burden-of-disease model combining data on the prevalence of hypertension, the incidence of major cardiovascular (CV) events and the costs of treating these events. The prevalence of uncontrolled hypertension was taken from the 1998 Health Survey for England. The incidences of three CV events, acute myocardial infarction, congestive heart failure and stroke, at different levels of achieved blood pressure, were estimated using results from the Hypertension Optimal Treatment study. Costs were taken from published sources. We estimated the number of major CV events and acute hospital costs that would be avoided if all people with hypertension had blood pressure treated to target levels.

Results: The model estimated that in the UK 5.7 million adults (12% of the population aged >16 years) have actual blood pressure above 160/95mm Hg, and a further 10.3 million (21%) have blood pressure in the range 140/90–160/95mm Hg. An estimated 58 000 major CV events per year occur in these patients that would be avoided if their blood pressure was at target levels. If all patients had blood pressure treated to target, the cost to the NHS of managing major CV events would fall by £97.2 million per year at 2000/01 prices (95% CI: £56–£144 million).

Conclusion: Failure to achieve blood pressure targets contributes substantially to avoidable NHS costs and to the number of CV events in the UK.