Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
PharmacoEconomics
Published in: PharmacoEconomics 14/2004

01-10-2004 | Review Article

Pharmacoeconomic Burden of Undertreating Hypertension

Authors: Luca Degli Esposti, Giorgia Valpiani

Published in: PharmacoEconomics | Issue 14/2004

Login to get access

Abstract

Many studies have shown the importance of antihypertensive drug therapy as a factor in reducing the risk of cardiovascular morbidity and mortality, and in containing the cost of managing hypertension and its complications. Nevertheless, the evidence in clinical practice indicates about half of hypertensive patients do not receive pharmacological treatment and about half of treated patients do not achieve blood pressure level control. Undertreating hypertension is the leading cause of failure in drug therapy effectiveness and cost effectiveness.
The pharmacoeconomic burden of undertreating hypertension can be defined as the clinical (number of cardiovascular events) and economic (costs of managing cardiovascular events) consequences that would have been avoided by adequate control of blood pressure levels. In the last few years, the increase in this burden and the restriction of budget constraints has raised the awareness of healthcare providers with regards to the need to achieve better performance and to improve disease management of hypertension.
This review aims to present the current situation regarding the pharmacoeconomic burden of undertreating hypertension by identifying the key issues of this medical condition, defining and measuring the extent of undertreatment, defining and measuring costs associated with undertreatment, and discussing some fundamental aspects of disease management for hypertension.
The pharmacoeconomic burden of undertreating hypertension appears to be an extremely important phenomenon for which there is currently only very limited adequate research. The present dearth of appropriate data can be largely attributed to the lack of epidemiological studies in clinical practice.
Future studies are necessary for a more precise quantification of the therapeutic and economic impact of undertreating arterial hypertension in clinical practice (appropriateness studies) and for more precise selection of antihypertensive drugs on the basis of the different cost-effectiveness profiles detected in ‘real world’ settings (cost-effectiveness studies).
Literature
1.
Burt VL, Whelton PK, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25 (3): 305–13PubMedCrossRef
2.
Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997; 157 (21): 2413–46CrossRef
3.
Stamler J. Blood pressure and high blood pressure: aspects of risk. Hypertension 1991; 18 Suppl. I: 95–107CrossRef
4.
Flack JM, Neaton J, Grimm Jr R, et al. for the Multiple Rick Factor Intervention Trial Research Group. Blood pressure and mortality among men with prior myocardial infarction. Circulation 1995; 92: 2437–45PubMedCrossRef
5.
Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997; 277: 739–45PubMedCrossRef
6.
Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am ColI Cardio1 1996; 27: 1214–8CrossRef
7.
Hodgson TA, Cohen AJ. Medical care expenditures for selected circulatory diseases: opportunities for reducing national expenditures. Med Care 1999; 37: 994–1012PubMedCrossRef
8.
Hodgson TA, Cai L. Medical care expenditure for hypertension, its complications, and its comorbidities. Med Care 2001; 39: 599–615PubMedCrossRef
9.
Croog SR, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–64PubMedCrossRef
10.
Mancia G, Giannattasio C. Benefit and costs of anti-hypertensive treatment. Eur Heart J 1995; 17 Suppl. A: 25–8
11.
Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population: data from the health examination survey, 1960 to 1991. Hypertension 1995; 26: 60–9PubMedCrossRef
12.
Joffres MR, Hamet P, Maclean DR, et al. Distribution of blood pressure and hypertension in Canada and United States. Am J Hypertens 2001; 14: 1099–105PubMedCrossRef
13.
Marques-Vidal P, Ruidavets JB, Cambou JP, et al. Trends in hypertension prevalence and management in Southwestern France, 1985–1996. J Clin Epidemiol 2000; 53: 1230–5PubMedCrossRef
14.
Banegas JR, Rodriguez-Artalejo F, José de la Cruz Troca J, et al. Blood pressure in Spain: distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension 1998; 32: 998–1002PubMedCrossRef
15.
16.
Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risk: US population data. Arch Intern Med 1993; 153: 598–615PubMedCrossRef
17.
American Heart Association. 2002 heart and stroke statistical update. Dallas (TX): American Heart Association, 2001
18.
MacMahon SW, Cutler JA, Furberg CD, et al. The effect of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized clinical trials. Prog Cardiovasc Dis 1986; 29 Suppl. 1: 99–118PubMedCrossRef
19.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64CrossRef
20.
Cutler JA, MacMahon SW, Furberg CD. Controlled trials of drug treatment of hypertension: a review. Hypertension 1989; 13 Suppl. I: 136–44
21.
Yusuf S, Thorn T, Abbott RD. Changes in hypertension treatment and in congestive heart failure mortality in the United States. Hypertension 1989; 13: 174–9CrossRef
22.
Mancia G. Treatment of hypertension and ischemic heart disease. J Cardiovasc Pharmacol 1989; 14 Suppl. 9: S12–9
23.
Guidelines for the management of mild hypertension: memorandum from a World Health Organization/International Society of Hypertension Meeting. J Hypertens 1993; 11: 905–18
24.
Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755–62PubMedCrossRef
25.
Zanchetti A, Hansson L, Menare J. Risk assessment and treatment benefit in intensively treated hypertensive patients of the Hypertension Optimal Treatment (HOT) study. J Hypertens 2001; 19: 819–25PubMedCrossRef
26.
Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC VII). JAMA 2003; 289: 2560–72CrossRef
27.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97CrossRef
28.
Appel LJ. The verdict from ALLHAT: thiazide diuretics are the preferred initial therapy for hypertension. JAMA 2002; 288: 3039–42PubMedCrossRef
29.
Menard J, Cornu P, Day M. Cost of hypertension treatment and the price of health. J Hum Hypertens 1992; 6: 447–58PubMed
30.
Elliot WJ. The costs of treating hypertension: what are the longterm realities of cost containment and pharmacoeconomics? Postgrad Med 1996; 99 (4): 241–52
31.
Giles TD. Pharmacoeconomic issues in antihypertensive therapy. Am J Cardiol 1999; 84: 25K-8KCrossRef
32.
Bernard DB, Townsend RR, Sylvestri MF. Health and disease management: what is it and where is it going? What is the role of health and disease management in hypertension? Am J Hypertens 1998; 11: 103S-8SCrossRef
33.
Elliott WJ. The economic impact of hypertension. J Clin Hypertens 2003; 5 Suppl. 2: 3–13CrossRef
34.
American Heart Association. 2003 heart and stroke statistical update. Dallas (TX): American Heart Association, 2002
35.
Manton KG, Corder L, Stallard E. Chronic disability trend in elderly United States population: 1982–1994. Proc Natl Acad Sci USA 1997; 94: 2593–8PubMedCrossRef
36.
Moser M. “Cost containment” in the management of hypertension. Ann Intern Med 1987; 107 (1): 107–9
37.
Fletcher A. Cost effective analyses in the treatment of high blood pressure. J Hum Hypertens 1992; 6: 437–45PubMed
38.
Kawachi I, Malcolm LA. The cost-effectiveness of treating mild-to-moderate hypertension: a reappraisal. J Hypertens 1991; 9: 199–208PubMedCrossRef
39.
Jonsson BG. Cost-benefit of treating hypertension. J Hypertens 1994; 12 Suppl. 10: S65–70
40.
Stason WB. Cost and quality trade-offs in the treatment of hypertension. Hypertension 1989; 13 Suppl. I: I145–8PubMedCrossRef
41.
Pardell H, Tresserras R, Armario P, et al. Pharmacoeconomic considerations in management of hypertension. Drugs 2000; 59 Suppl. 2: 13–20CrossRef
42.
Johannesson M. The cost effectiveness of hypertension treatment in Sweden. Pharmacoeconomics 1995; 7 (3): 242–50PubMedCrossRef
43.
Hughes DA, Bagust A, Haycox A, et al. Accounting for noncompliance in pharmacoeconomic evaluations. Pharmacoeconomics 2001; 19 (12): 1185–97PubMedCrossRef
44.
Urquhart J. Pharmacoeconomic consequences of variable patient compliance with prescribed drug regimens. Pharmacoeconomics 1999; 15 (3): 217-28
45.
Urquhart J. Patient non-compliance with drug regimens: measurement, clinical correlates, economic impact. Eur Heart J 1996; 17 Suppl. A: 8–15
46.
Bloom BS. Daily regimen and compliance with treatment. BMJ 2000; 323 (7314): 64–7
47.
Payne KA, Esmonde-White S. Observational studies of antihypertensive medication use and compliance: is drug choice a factor in treatment adherence? Curr Hypertens Rep 2000; 2: 515–24PubMedCrossRef
48.
Gerth WC. Compliance and persistence with newer antihypertensive agents. Curr Hypertens Rep 2002; 4: 424–33PubMedCrossRef
49.
Degli Esposti L, Degli Esposti E, Valpiani G, et al. A retrospective, population-based analysis on persistence with antihypertensive drug therapy in primary care practice in Italy. Clin Ther 2002; 24 (8): 1347–57PubMedCrossRef
50.
Marentette MA, Gerth WC, Billings DK, et al. Antihypertensive persistence and drug class. Can J Cardiol 2002; 18: 649–56PubMed
51.
Conlin PR, Gerth WC, Fox J, et al. Four-year persistence patterns among patients initiating therapy with the angiotensin II receptor antagonist losartan versus other antihypertensive drug classes. Clin Ther 2001; 23: 1999–2010PubMedCrossRef
52.
Caro JJ, Salas M, Speakman JL, et al. Persistence with treatment for hypertension in actual practice. CMAJ 1999; 160: 31–7PubMed
53.
Bloom BS. Continuation of initial antihypertensive rredicatlon after 1 year of therapy. Clin Ther 1998; 20 (4): 671–81PubMedCrossRef
54.
Monane M, Bohn RL, Gurwitz JH, et al. The effects of initial drug choice and comorbidity on antihypertensive compliance: results from a population-based study in the elderly. Am J Hypertens 1997; 10: 697–704PubMedCrossRef
55.
Okano GJ, Rascati KL, Wilson JP, et al. Patterns ofhypertensive use among patients in the US Department of Defence database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker. Clin Ther 1997; 19: 1433–45PubMedCrossRef
56.
Jones JK, Gorkin L, Lian JR, et al. Discontinuation of and changes in the treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ 1995; 311: 293–5PubMedCrossRef
57.
Caro JJ, Speakman JL, Salas M, et al. Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. CMAJ 1999; 160: 41–6PubMed
58.
Benson S, Vance-Bryan K, Raddatz J. Time to patient discontinuation of antihypertensive drug in difference classes. Am J Health Syst Pharm 2000; 57: 51–4PubMed
59.
Degli Esposti E, Sturani A, Di Martino M. Long-term persistence with antihypertensive drugs in new patients. J Hum Hypertens 2002; 16: 439–44PubMedCrossRef
60.
Degli Esposti E, Sturani A, Degli Esposti L, et al. Pharmacoutilization of antihypertensive drugs: a model of analysis. Int J Clin Pharm Ther 2001; 39: 251–8
61.
Monane M, Bohn RL, Gurwitz JH, et al. Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender and race. Am J Public Health 1996; 86: 1805–8PubMedCrossRef
62.
Pham HT, Gause D, Frech FR. Discontinuation, switching and adding among hypertensive drug classes. Am J Hypertens 2001; 14 (Pt 2): 112ACrossRef
63.
Wogen J, Krejilick CA, Livornese RC, et al. A population-based study of compliance and persistency with cardiovascular agents used in hypertension management. Am J Hypertens 2001; 14 (Pt 2): 12A
64.
Wannemacher AJ, Schepers GP, Townsend KA. Antihypertensive indication compliance in a Veterans Affairs healthcare system. Ann Pharmacother 2002; 36: 986–91PubMedCrossRef
65.
Hasford J, Mimran A, Simon WR. A population-based European cohort study of persistence in newly diagnosed hypertensive patients. J Hum Hypertens 2002; 16: 569–75PubMedCrossRef
66.
Conlin PR, Fox J, Gerth WC, et al. Losartan/angiotensin II antagonists have greater persistence than other antihypertensive agents/classes. Am J Hypertens 2002; 15 (Pt 2): 29ACrossRef
67.
Caput AJ. Persistency with angiotensin receptor blockers (ARB) versus other antihypertensives (ART) using Saskatchewan Database. Can J Cardiol 2000; 16 Suppl. F: 194F
68.
Mann RD, Mackay F, Pearce G, et al. Losartan: a study of pharmacovigilance data on 14,522 patients. J Hum Hypertens 1999; 13: 551–7PubMedCrossRef
69.
Nelson EC, Stason WE, Neutra RB, et al. Identification of the noncompliant hypertensive patient. Prev Med 1980; 9: 504–17PubMedCrossRef
70.
Caro JJ. Stepped care for hypertension: are the assumptions valid? J Hypertens 1997; 15 Suppl. 7: S35–9
71.
Goldberg AI, Dunlay MC, Sweet CS, et al. Safety and tolerability of losartan potassium, an angiotensin II receptor antagonist, compared to hydrochlorothiazide, atenolol, felodipine ER, and angiotensin-converting enzyme inhibitors for the treatment of systemic hypertension. Am J Cardiol 1995; 75: 793–5PubMedCrossRef
72.
Moore MA, Edelman JM, Gadick LP, et al. Choice of initial antihypertensive medication may influence the extent to which patients stay on therapy: a community-based study oflosartanbased regimen vs usual care. High Blood Press 1998; 7: 156–67
73.
Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–64PubMedCrossRef
74.
Shulman N, Cutter G, Daugherty R, et al. Correlates of attendance and compliance in the hypertension detection and follow-up program. Control Clin Trials 1982; 3: 13–27PubMedCrossRef
75.
Black DM, Brand RJ, Greenlick M, et al. for the SHEP Pilot Research Group. Compliance to treatment for hypertension in elderly patients: the SHEP pilot study. J Gerontol 1987; 42: 552–7PubMedCrossRef
76.
Neaton JD, Grimm Jr RH, Prineas RJ, et al. for the reatment of Mild Hypertension Study Research Group. Treatment of mild hypertension: final results. JAMA 1993; 270: 713–24PubMedCrossRef
77.
Skaer TL, Sclar DA, Robison LM. Noncompliance with antihypertensive therapy: economic consequences. Pharmacoeconomics 1996; 9 (1): 14CrossRef
78.
79.
Drummond MF, O’Brien BJ, Stoddart JL, et al. Methods for the economic evaluation of health care programmes. New York: Oxford University Press, 1997
80.
Drummond MF, McGuire A. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001
81.
Degli Esposti L, Baio G, Valpiani G. Cost allocation in antihypertensive drug therapies. Exp Rev Pharmacoeconomics Outcomes Res 2002; 2 (5): 419–26CrossRef
82.
Paramore LC, Haltern MT, Lapuerta P, et al. Impact of poorly controlled hypertension on healthcare resource utilization and cost. Am J Manag Care 2001; 7: 389–98PubMed
83.
Hughes D, McGuire A. The direct costs to the NHS of discontinuing and switching prescriptions for hypertension. J Hum Hypertens 1998; 12: 533–7PubMedCrossRef
84.
Rizzo JA, Simons RW. Variations in compliance among hypertensive patients among drug class: implications for health care costs. Clin Ther 1997; 19: 1446–57PubMedCrossRef
85.
McCombs JS, Nichol ME, Newman CM, et al. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care 1994; 32: 214–26PubMedCrossRef
86.
Stason WB. Effectiveness and costs of veteran affairs hypertension clinics. Med Care 1994; 32 (12): 1197–215PubMedCrossRef
87.
Skaer TL, Sclar DA, Robison LM, et al. Effect of pharmaceutical forrmlation for diltiazem on health care expenditures for hypertension. Clin Tiler 1993; 15 (5): 905–11
88.
Maronde RF, Chan LS, Larsen FJ, et al. Underutilization of antihypertensive drugs and associated hospitalization. Med Care 1989; 27 (12): 1159–66PubMedCrossRef
89.
Lapuerta P, Simon T, Smitten A, et al. Assessment of the association between blood pressure control and health care resource use. Clin Ther 2001; 23 (10): 1773–82PubMedCrossRef
90.
Mar J, Rodriguez-Artalejo F. Which is more important for the efficiency of hypertension treatment: hypertension stage, type of drug or therapeutic compliance? J Hypertens 2001; 19: 149–55PubMedCrossRef
91.
Spence JD, Hurley TC, Spence JD. Actual practice in hypertension: implications for persistence with and effectiveness of therapy. Curr Hypertens Rep 2001; 3: 481–7PubMedCrossRef
92.
Jackson JD, Merat P. Unmet needs in hypertension: challenges and opportunities. Curr Hypertens Rep 1999; 1 (6): 495–501PubMedCrossRef
93.
Epstein RS, Sherwood LM. From outcomes management to disease management: a guide for the perplexed. Ann Intern Med 1996; 124 (9): 832–7PubMed
94.
95.
Black N. Improving the use of clinical databases [letter]. BMJ 2002; 234: 1194CrossRef
96.
97.
Shortliffe EH, Perrault LE, Wiederhold GIO, et al. Medical informatics. 2nd ed. New York: Springer, 2001
98.
Quam L, Ellis LBM, Venus P, et al. Using claims data for epidemiologic research. Med Care 1993; 31 (6): 498–507PubMedCrossRef
99.
Mitchell JB, Bubolz T, Paul JE, et al. Using Medicare claims for outcome research. Med Care 1994; 32 (7 Suppl.): JS38–51
100.
Birnbaum HG, Cremieux PY, Greenberg PE, et al. Using healthcare claims data for outcome research and pharmacoeconomic analyses. Phannacoeconomics 1999; 16: 1–8CrossRef
101.
Motheral BR, Fairman KA. The use of claims databases for outcome research: rational challenges and strategies. Clin Ther 1997; 19 (2): 346–66PubMedCrossRef
102.
Black N. Why do we need observational studies to evaluate the effectiveness of health care? BMJ 1996; 312: 1215–8PubMedCrossRef
103.
Revicki DA, Frank L. Phannacoeconomic evaluation in the real world. Pharmacoeconomics 1999; 15 (5): 423–34PubMedCrossRef
104.
Psaty BM, Siscovick DS, Weiss NS, et al. Hypertension and outcomes research: from clinical trials to clinical epidemiology. Am J Hypertens 1996; 9: 178–83PubMedCrossRef
105.
106.
Greenberg PE, Almudena A, Birnbaum HG, et al. Pharmacoeconomics and health policy: current applications and prospects for the future. Pharmacoeconomics 1999; 16 (5): 425–32PubMedCrossRef
107.
Baltussen R, Leidl R, Ament A. Real world designs in economic evaluation: bridging the gap between clinical research and policy-making. Pharmacoeconomics 1999; 16 (5): 449–58PubMedCrossRef
Metadata
Title
Pharmacoeconomic Burden of Undertreating Hypertension
Authors
Luca Degli Esposti
Giorgia Valpiani
Publication date
01-10-2004
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 14/2004
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200422140-00002