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    High blood pressure: What employers can do to lower the cost



    At Work With the CDC

    High blood pressure:
    What employers can do to lower the cost

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    Hypertension is common and very costly. Employers can have a big impact on this health problem for a relatively small investment.

    By Diane R. Orenstein, PhD, and Carma Ayala, MPH, PhD

    High blood pressure affects about one in four Americans—some 50 million people—and is even more common among some racial/ethnic groups and older adults. Only 68 percent of those affected are aware of their condition, only 54 percent are treated, and only 27 percent have their blood pressure controlled, according to The Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).

    The condition is often defined by a systolic (heart is beating), blood pressure reading of 140 mm Hg or higher, or a diastolic (heart is resting between beats) reading of 90 mm Hg or higher. Note that elevation of either number can merit treatment. Note also that high blood pressure increases the risk for heart disease and stroke; even modest elevations are associated with increased hospitalizations and deaths.1

    High blood pressure has been reported as a primary reason for patient visits to physician's offices,2 and drugs that control high blood pressure are the most commonly prescribed medications in the U.S.3 Treating high blood pressure has become a major commitment of physicians and organized health plans, particularly given an aging population and increased awareness of the benefits of treatment guidelines and aggressive detection. Results from large-scale trials, for instance, indicate that a 5 mm Hg reduction in diastolic pressure corresponds to a 21 percent reduction in heart disease rates.4

    The total direct and indirect cost of high blood pressure in the United States in 2001 was an estimated $47.2 billion.5 Even if prevalence remains constant, population growth and inflation will escalate its cost (See chart.) Preventing high blood pressure should be the first priority in preventing heart disease and stroke and, not incidentally, helping businesses, insurers and health care organizations contain costs.

    The 1995 study "Five-hundred life saving interventions and their cost effectiveness," reported that primary prevention is more cost-effective than secondary or tertiary prevention.6 The projected overall cost of high blood pressure can be greatly reduced through prevention and control. For example, an estimated average of $3 billion a year could be saved if just one in 20 adults could prevent high blood pressure through lifestyle modifications.

    Role of business in prevention and control

    A survey of health care providers and employees conducted by the U.S. Department of Health and Human Services7 indicated that the worksite is the single most important place to systematically reach adults. Efforts to improve employee health and reduce costs for businesses, insurers and health care organizations should include a strong emphasis on education. The central messages: High blood pressure is a major modifiable risk factor for heart disease, stroke and kidney disease. Blood pressure checks are an important first step in identifying and controlling the disease. Good nutrition, physical activity and smoking cessation can all help prevent or control high blood pressure.

    Policy and environmental strategies are also prime areas for business collaboration with unions, health care associations, professional organizations, hospitals and even fire departments. Businesses can also:

    • Partner with state or local health departments and community organizations to develop and foster policies and working conditions that ensure appropriate employee screening and follow-up.
    • Use the help that is available from the Centers for Disease Control and Prevention (CDC), Cardiovascular Health Branch, the National High Blood Pressure Education Program and the American Heart Association to promote programs that increase public awareness and understanding about high blood pressure as a risk factor for heart disease and stroke.
    • Purchase employee health plans that provide or reimburse for blood pressure screening, lifestyle modification counseling, self-measuring of blood pressure as needed, and new antihypertensive medications in accordance with JNC VI guidelines.
    • Encourage health care providers to implement JNC VI guidelines so adults aged 20 years and older have blood pressure checks at least every two years.
    • Establish collaborative management and employee groups to develop programs that provide education and interventions to increase employees' physical activity, knowledge about good diet and nutrition, and stress-reduction skills.

    High blood pressure is a major modifiable risk factor for cardiovascular disease. Blood pressure screening is an important first step in preventing and controlling not only high blood pressure but also heart disease and stroke. For employees, this may help reduce high blood pressure and its sequelae, improve productivity, and possibly reduce sick days. All of these results offer a healthier workforce and a financial benefit to employers.

    Diane R. Orenstein and Carma Ayala both work in the Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention in Atlanta, Georgia.

    Be sure to check out previous "At Work With the CDC" columns in our archive.


    1 MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke and coronary heart disease, I: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765-774.

    2 Schappert SM, Nelson C. National Ambulatory Medical Care Survey: 1995-96 Summary, 1999. Vital Health Stat. Series 13, No. 142.

    3 Baum C, Kennedy DL, Knapp DE, et al. Prescription drug use in 1984 and changes over time. Medical Care 2001;39:599-615.

    4 The Sixth Report of the Joint National Committee on Prevention: detection, evaluation, and treatment of high blood pressure (JNC-VI). Archives of Internal Medicine 1997;157:2413-2446.

    5 Hodgson TA, Cai L. Medical care expenditures for hypertension, its complications, and its comorbidities. Medical Care 2001;39:599-615.

    6 Tengs TO, Adams ME, Pliskin JS, et al. Five hundred life saving interventions and their cost effectiveness. Risk Analysis 1995;15:369-90.

    7 Lewis CE. Disease prevention and health promotion practices of primary care physicians in the United States. American Journal of Preventive Medicine 1988;4 (suppl):9-16.

    Projected costs of high blood pressure


    Click here to view full-size graphic

    The cost of high blood pressure in the U.S. last year was estimated at over $47 billion. The total will range from $69 to nearly $90 billion by the end of the decade, depending on the rate of inflation for health care costs. Calculations are based on population growth and inflation with no change in prevalence of high blood pressure from its 2000 rate.

    Source: Hodgson TA, Cai L. Medical care expenditures for hypertension, its complications, and its comorbidities. Med Care 2001; 39:599-615.


    For information on cardiovascular health promotion and disease prevention visit:

    The Cardiovascular Health Program at CDC

    The National Heart, Lung and Blood Institute at the National Institutes of Health

    The American Heart Association

    For health and cost information, recommendations, and guidance for businesses, insurers, and employees visit:

    The Washington Business Group on Health

    The Wellness Councils of America

    The Association of Worksite Health Promotion

    More Business & Health Articles on Hypertension

    More bang for the buck in managing high blood pressure (May 1996)

    Costing Out Care (August 1998)


    Diane Orenstein, Carma Ayala. High blood pressure: What employers can do to lower the cost. Business and Health 2002;14.

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