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# Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003–2014

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### Abstract

##### Background

One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension.

### Most cited references8

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### Deaths preventable in the U.S. by improvements in use of clinical preventive services.

(2010)
Healthcare reform plans refer to improved quality, but there is little quantification of potential health benefits of quality care. This paper aims to estimate the health benefits by greater use of clinical preventive services. Two mathematical models were developed to estimate the number of deaths potentially prevented per year by increasing use of nine clinical preventive services. One model estimated preventable deaths from all causes, and the other estimated preventable deaths from specific categories of causes. Models were based on estimates of the prevalence of risk factors for which interventions are recommended, the effect of those risk factors on mortality, the effect of the interventions on mortality in those at risk, and current and achievable rates of utilization of the interventions. Both models predicted substantial numbers of deaths prevented by greater use of the preventive services, with the greatest increases from services that prevent cardiovascular disease. For example, the all-cause model predicted that every 10% increase in hypertension treatment would lead to an additional 14,000 deaths prevented and every 10% increase in treatment of elevated low-density lipoprotein cholesterol or aspirin prophylaxis would lead to 8000 deaths prevented in those aged <80 years, per year. Overall, the models suggest that optimal use of all of these interventions could prevent 50,000-100,000 deaths per year in those aged <80 years and 25,000-40,000 deaths per year in those aged <65 years. Substantial improvements in population health are achievable through greater use of a small number of preventive services. Healthcare systems should maximize use of these services. 2010 American Journal of Preventive Medicine. All rights reserved.
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### National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity

(2017)
Background National heart failure (HF) hospitalization rates have not been appropriately age-standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. Methods and Results The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 U.S. standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100,000 between 2002 and 2013. While hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for males compared to females increased from 20% greater to 39% (p-for-trend=0.002) between 2002 and 2013. Black males had a rate that was 229% (p-for-trend=0.141) and black females 240% (p-for-trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic males had a rate that was 32% greater in 2002 and the difference narrowed to 4% (p-for-trend=0.047) greater in 2013 relative to whites. For Hispanic females the rate was 55% greater in 2002 and narrowed to 8% greater (p-for-trend=0.004) in 2013 relative to whites. Asian/Pacific Islander (PI) males had a 27% lower rate in 2002 that improved to 43% (p-for-trend=0.040) lower in 2013 relative to whites. For Asian/PI females the hospitalization rate was 24% lower in 2002 and improved to 43% (p-for-trend=0.021) lower in 2013 relative to whites. Conclusions National HF hospitalization rates have decreased steadily over the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. The evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/PI are needed.
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### 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines

(2018)
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### Author and article information

###### Contributors
kirklane@musc.edu
###### Journal
J Am Heart Assoc
J Am Heart Assoc
10.1002/(ISSN)2047-9980
JAH3
ahaoa
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
John Wiley and Sons Inc. (Hoboken )
2047-9980
30 May 2018
05 June 2018
: 7
: 11 ( doiID: 10.1002/jah3.2018.7.issue-11 )
###### Affiliations
[ 1 ] Division of General Internal Medicine and Geriatrics Department of Medicine Medical University of South Carolina Charleston SC
[ 2 ] Section of Health Systems Research and Policy Department of Medicine Medical University of South Carolina Charleston SC
[ 3 ] Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) Ralph H. Johnson VA Medical Center Charleston SC
###### Author notes
[* ] Correspondence to: Elizabeth B. Kirkland, MD, MSCR, Division of Internal Medicine and Geriatrics, Medical University of South Carolina, 135 Rutledge Avenue, 12th Floor, MSC 591, Charleston, SC 29425. E‐mail: kirklane@ 123456musc.edu
###### Article
JAH33164
10.1161/JAHA.118.008731
6015342
29848493
© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

###### Page count
Figures: 2, Tables: 2, Pages: 9, Words: 5868
###### Categories
Original Research
Original Research
Hypertension
2.0
jah33164
05 June 2018
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Cardiovascular Medicine