Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Health care utilisation and out-of-pocket expenditure associated with hypertension: an analysis of Australian adults from the 45 and Up Study

Journal of Human Hypertension volume 34, pages 833–840 (2020)Cite this article

Subjects

Abstract

Hypertension is a common condition worldwide that significantly increases morbidity and mortality rates in the older population. A number of treatment options are available to control blood pressure. The purpose of this study was to assess the use of health services and self-care amongst people with hypertension and to estimate the out-of-pocket expenses associated with such health care use. A sub-study of the 45 and Up Study was conducted amongst 1300 individuals who had earlier reported a clinical diagnosis of hypertension in 2017. A total of 753 (57.9%) individuals with hypertension returned a completed questionnaire. In the last 12 month, for their hypertension management, 84% of participants consulted a doctor, 19% of them consulted an allied health practitioner and 9% of them consulted a complementary medicine practitioner. The average total out-of-pocket expenditure for hypertension-related health care was Australian $461.8 per annum, with an estimated Australian $941 million per annum if extrapolated to all Australians aged 55 years and over with hypertension. Older people with hypertension use a wide range of health services to control their blood pressure including conventional medicine, allied health and complementary medicine practitioners as well as various self-care practices. A substantial amount of out-of-pocket expenditure has been spent on hypertension care annually. Given the global health and economic burden of hypertension, there is an urgent need for more research exploring cost-effective management(s) for hypertensive patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Egan BM, Kjeldsen SE, Grassi G, Esler M, Mancia G. The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard? J Hypertens. 2019;37:1148–53.

    Article  CAS  Google Scholar 

  2. World Health Organization. Cardiovascular diseases (CVDs). 2017. https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).

  3. Soni RK, Porter AC, Lash JP, Unruh ML. Health-related quality of life in hypertension, chronic kidney disease, and coexistent chronic health conditions. Adv Chronic Kidney Dis. 2010;17:e17–26.

    Article  Google Scholar 

  4. Baral-Grant S, Haque M, Nouwen A, Greenfield S, McManus R. Self-monitoring of blood pressure in hypertension: a UK primary care survey. Int J Hypertens. 2011;2012:582068.

    PubMed  PubMed Central  Google Scholar 

  5. Okin PM, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Impact of lower achieved blood pressure on outcomes in hypertensive patients. J Hypertens. 2012;30:802–10.

    Article  CAS  Google Scholar 

  6. Ibrahim MM, Damasceno A. Hypertension in developing countries. Lancet. 2012;380:611–9.

    Article  Google Scholar 

  7. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B, et al. CDC grand rounds: a public health approach to detect and control hypertension. MMWR Morb Mortal Wkly Rep. 2016;65:1261–4.

    Article  Google Scholar 

  8. Lo SH, Chau JP, Woo J, Thompson DR, Choi KC. Adherence to antihypertensive medication in older adults with hypertension. J Cardiovasc Nurs. 2016;31:296–303.

    Article  Google Scholar 

  9. Rochefort CM, Morlec J, Tamblyn RM. What differentiates primary care physicians who predominantly prescribe diuretics for treating mild to moderate hypertension from those who do not? A comparative qualitative study. BMC Fam Pract. 2012;13:9.

    Article  Google Scholar 

  10. Centers for Disease Control and Prevention. Self-management support and education. 2017. https://www.cdc.gov/dhdsp/pubs/guides/best-practices/self-management.htm.

  11. The Ministry of Health and Medical Services, Fiji Health Sector Support Program, Australian Aid. Cardiovascular therapeutic guidelines. 2015. http://www.health.gov.fj/wp-content/uploads/2018/03/Cardiovascular-Drug-Guidelines.pdf.

  12. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 2019. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/red-book/prevention-of-vascular-and-metabolic-disease/blood-pressure.

  13. Penaloza-Ramos MC, Jowett S, Mant J, Schwartz C, Bray EP, Sayeed Haque M, et al. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR). Eur J Prev Cardiol. 2016;23:902–12.

    Article  Google Scholar 

  14. Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol. 2013;29:579–85.

    Article  Google Scholar 

  15. Sibbritt D, Davidson P, Peng W, Adams J, Hickman L. Hypertension: what are the self-care and health-care-seeking behaviours in women over time? J Hum Hypertens. 2016;30:783–7.

    Article  CAS  Google Scholar 

  16. Potthoff SA, Vonend O. Multidisciplinary approach in the treatment of resistant hypertension. Curr Hypertens Rep. 2017;19:9.

    Article  CAS  Google Scholar 

  17. Harris MF, Williams AM, Dennis SM, Zwar NA, Powell Davies G. Chronic disease self‐management: implementation with and within Australian general practice. Med J Aust. 2008;189:S17–20.

    Article  Google Scholar 

  18. Hu H, Li G, Duan J, Arao T. Prevalence, purposes, and perceived effectiveness of complementary and alternative medicine use in a hypertension population: a questionnaire survey. Int Sch Res Not. 2013;2013:137472.

    Google Scholar 

  19. Rahmawati R, Bajorek BV. Self-medication among people living with hypertension: a review. Fam Pract. 2017;34:147–53.

    PubMed  Google Scholar 

  20. 45 and Up Study Collaborators, Banks E, Redman S, Jorm L, Armstrong B, Bauman A, et al. Cohort profile: the 45 and up study. Int J Epidemiol. 2008;37:941–7.

    Article  Google Scholar 

  21. Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Canberra: Australian Institute of Health and Welfare; 2004.

    Google Scholar 

  22. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff. 2001;20:267–78.

    Article  CAS  Google Scholar 

  23. Karter AJ, Stevens MR, Herman WH, Ettner S, Marrero DG, Safford MM, et al. Out-of-pocket costs and diabetes preventive services: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2003;26:2294–9.

    Article  Google Scholar 

  24. Australian Bureau of Statistics. Australian demographic statistics. 2017. https://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/0DEC5B368C5C2D72CA2581F5001011EB/$File/31010_jun%202017.pdf.

  25. Australian Institute of Health and WelfareCardiovascular disease. 2019. https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease.

  26. Lip GY, Felmeden DC, Dwivedi G. Antiplatelet agents and anticoagulants for hypertension. Cochrane Database Syst Rev. 2011;12:CD003186.

    Google Scholar 

  27. Borghi C, Dormi A, Veronesi M, Immordino V, Ambrosioni E. Use of lipid‐lowering drugs and blood pressure control in patients with arterial hypertension. J Clin Hypertens. 2002;4:277–85.

    Article  Google Scholar 

  28. Kim KI, Ihm SH, Kim GH, Kim HC, Kim JH, Lee HY, et al. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2019;25:19.

    Article  Google Scholar 

  29. Elliott WJ. Improving outcomes in hypertensive patients: focus on adherence and persistence with antihypertensive therapy. J Clin Hypertens. 2009;11:376–82.

    Article  CAS  Google Scholar 

  30. Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012;345:e6341.

    Article  Google Scholar 

  31. Constant AF, Geladari EV, Geladari CV. The economic burden of hypertension. In: Andreadis EA (editors). Hypertension and cardiovascular disease. 1st ed. Springer: Switzerland; 2016. p. 351–60.

  32. Kirkland EB, Heincelman M, Bishu KG, Schumann SO, Schreiner A, Axon RN, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003–2014. J Am Heart Assoc. 2018;7:e008731.

    Article  Google Scholar 

  33. Nakamura K, Okamura T, Miura K, Okayama A. Hypertension and medical expenditure in the Japanese population: review of prospective studies. World J Cardiol. 2014;6:531–8.

    Article  Google Scholar 

  34. Zhang D, Wang G, Zhang P, Fang J, Ayala C. Medical expenditures associated with hypertension in the US, 2000–2013. Am J Prev Med. 2017;53:S164–71.

    Article  Google Scholar 

Download references

Acknowledgements

This research was completed by using data collected through the 45 and Up Study (www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family & Community Services—Ageing, Carers and the Disability Council NSW; and the Australian Red Cross Blood Service. We thank the many thousands of people participating in the 45 and Up Study. We extend our sincere thanks to the Australian Research Council for funding Distinguished Professor JA via an ARC Professorial Future Fellowship (FT140100195) while working on this paper.

Author information

Authors and Affiliations

  1. School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

    Jon Adams, Mahdie Hosseini, Wenbo Peng & David Sibbritt

Authors
  1. Jon Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahdie Hosseini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wenbo Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Sibbritt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DS and JA conceived this study and obtained ethical approval. DS and WP conducted data analysis. JA and MH wrote the first draft of the paper. DS and WP revised the paper. All authors approved the submitted version of the paper.

Corresponding author

Correspondence to David Sibbritt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adams, J., Hosseini, M., Peng, W. et al. Health care utilisation and out-of-pocket expenditure associated with hypertension: an analysis of Australian adults from the 45 and Up Study. J Hum Hypertens 34, 833–840 (2020). https://doi.org/10.1038/s41371-020-0363-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-020-0363-z

Search

Advanced search

Quick links