The cost of treating hypertension: can we keep it under control without compromising the level of care?

The cost of hypertension treatment can be contained without compromising outcome. National recommendations for the routine diagnostic evaluation of hypertensive subjects do not include echocardiograms or ambulatory monitoring. These are expensive procedures, which, if performed in only a fraction of the total hypertensive population, would add several billion dollars to the cost of care. At present there are no data indicating that outcome of treatment would be improved. Costs of labeling before a definitive diagnosis is made, continuing lifestyle modification too long, medication switching, and not treating to goal blood pressures also increase cost without increased benefit. Although there are special indications for the more expensive newer medications, the majority of patients can be managed, at least initially, with less expensive therapies. Cost should not be a consideration, however, if one therapy has been shown to be more beneficial than another. Finally, the benefits of antihypertensive drug therapy have been underestimated because of the lack of consideration of prevention of left ventricular hypertrophy or progression to more severe disease by early treatment. On the other hand, the cost per quality of life-years saved has been overestimated. Pharmacoeconomic models may serve to mislead practitioners regarding treatment decisions.