LONG-TERM COST AND LIFE-EXPECTANCY CONSEQUENCES OF HYPERTENSION

Objective To estimate hypertension's long-term cost and impact on life expectancy. Design A 19-year individual follow-up study. Subjects wer e categorized according to their baseline (1972) diastolic blood press ure (DBP) level into three groups: normotensive (DBP < 95 mmHg), mildl y hypertensive (DBP 95-104 mmHg), and severely hypertensive (DBP >104 mmHg), By using their social security identification numbers, we linke d the subjects to a set of national registers covering hospital admiss ions, use of major drugs, absence due to sickness, disability pensions , and deaths. Subjects A random population sample of 10 284 men and wo men aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. Main outcome measures The numbers of years of life a nd years of work lost, the cost of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality, Results The difference in life expectancy between normotensive and sev erely hypertensive men was 2.7 years, of which 2.0 years was due to ca rdiovascular disease (CVD). Among women the corresponding differences were 2.0 and 1,5 years, Severely hypertensive men lost 2.6 years of wo rk more than did normotensive men, of which 1,7 years was due to CVD, Among women the differences were 2.2 and 1.3 years. The mean undiscoun ted total costs (USA dollars at 1992 prices) were $132 500 among normo tensive, $146 500 among mildly hypertensive, and $219 300 among severe ly hypertensive men, of which CVD accounted for 28, 39, and 43%, respe ctively. More than 90% of the total costs were indirect productivity l osses. Among women the total costs were lower for all DBP categories, as were the shares of CVD-related costs. The proportional increase cos ts on going from the lowest to the highest DBP category was, however, somewhat larger among women. Conclusions On the population level, seve re hypertension leads to considerable losses in terms of years of life lost, years of work lost, and costs, However, the overall impact of m ild hypertension is much more limited. J Hypertens 16:1103-1112. (C) 1 998 Lippincott-Raven Publishers.