Assessment of the association between blood pressure control and health care resource use

Background: Several studies have reported increased health care resource us e among hypertensive patients with uncontrolled blood pressure (BP). Objective: The purpose of this study was to investigate the relationship be tween BP control and health care resource use. Methods: Data were obtained from the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study, a multicenter feasibility study of actual physician and patient behavior and clinical outcomes in a naturalis tic setting. Adult patients with newly dia-nosed hypertension were randomiz ed to either Group I (treatment with diuretics or betablockers) or Group 2 (treatment with calcium channel blockers or angiotensin-converting enzyme i nhibitors) and followed for 5 +/- 1 months. Physicians practiced standard c are while documenting, medications, BP measurements, and health care resour ce use for their patients. A subsequent analysis evaluating the relationshi p between BP and physician visits was performed for the whole population an d for a subpopulation of patients with at least 4 months of follow-up data. Cox regression was used to model time to next visit. Results: A total of 512 patients with newly diagnosed hypertension were fol lowed; 399 had follow-up data for at least 4 months. Baseline demographic c haracteristics were similar in the 2 groups. Kaplan-Meier curves and a log- rank test showed that the time to next visit for patients with uncontrolled BP was significantly shorter than for patients whose BP was controlled (P < 0.05). On average, patients with uncontrolled BP (greater than or equal t o 140/90 mm Hg) had follow-up office visits similar to 13 days earlier than patients with controlled BP (< 140/90 mm Hg). This association remained si gnificant after adjustment for repeated measures, and after exclusion of th e first return visit. Cox regression analysis showed that higher systolic a nd diastolic BP measurements were significantly associated with a shorter t ime to next visit, after adjustment for age and sex. Total estimated costs during the study period were $170 per patient for medications and $283 per patient for office visits. Conclusions: In the CHOICE study, higher BP was associated with a shorter t ime to next visit. Office visits were the main cost driver in the short-ter m management of hypertension.