Cost and yield of the hypertensive evaluation. Experience of a community-based referral clinic.

During the first 5 years of a community-based referral hypertension clinic, 331 ambulatory patients referred for diagnostic evaluation. Thirty-four patients were judged to be normotensive on the basis of resting blood pressures on 3 separate days. In 51 patients the diagnosis was borderline hypertension and 220, essential hypertension. Twenty-six patients (10.6%) had secondary hypertension. Twenty-one patients with secondary hypertension were first recognized from the data of the history, physical examination, and routine urinalysis. The main cost per patient of the initial and further evaluations was computed for each group of patients. The average cost to identify one case of secondary hypertension in the clinic was $2083. Because of the large problem with hypertension in the United States today, the cost-effectiveness of various approaches to the evaluation of patients with hypertension requires thoughtful reappraisal.