Power of Prevention: The Health and Economic Benefits of Preventing Chronic Diseases

Cost-Effectiveness of High Blood Pressure Interventions

High blood pressure is a common and dangerous condition and a key risk factor for heart disease and stroke. It is defined as having a blood pressure of 130/80 mm Hg or higher. Healthy lifestyle behaviors—like eating a diet high in fruits and vegetables and low in sodium and being physically active—can help prevent and control high blood pressure.

High Blood Pressure in the United States

  • Nearly 1 in 2 US adults (116 million) has high blood pressure, and most of them (92 million) may need to both change their lifestyle and take prescription medicine.1
  • About 3 in 4 US adults with high blood pressure (92 million) don’t have it under control (defined as blood pressure less than 130/80 mm Hg).1
  • High blood pressure rates vary by race and ethnicity. Over half (56%) of non-Hispanic Black adults, 48% of non-Hispanic White adults, 46% of non-Hispanic Asian adults, and 39% of Hispanic adults in the United States have high blood pressure. Only 18% of non-Hispanic Black adults, 22% of non-Hispanic White adults, 14% of non-Hispanic Asian adults, and 14% of Hispanic adults with high blood pressure have it under control.1
  • Over 500,000 US deaths each year are linked to high blood pressure as a primary or contributing cause.2

The Benefits of Using Proven Strategies

Many effective strategies to manage high blood pressure are a good value in terms of cost per quality-adjusted life year (QALY) gained.* For example:

  • Team-based care to improve blood pressure control has a median cost of $9,716 to $13,992‡(a) per QALY gained.3
  • The use of community health workers, especially as part of a team, has a median estimated cost of $17,670‡(b) per QALY gained.5
  • When used with other approaches, self-measured blood pressure monitoring has a median cost of $2,800 to $10,800‡(c) per QALY gained.6

Strategies That Work

CDC supports state, local, tribal, and territorial heart disease and stroke prevention programs that help millions of Americans control their high blood pressure and reduce other risk factors for heart disease and stroke. The agency promotes strategies and policies that encourage healthy lifestyles and behaviors, healthy environments and communities, and access to early and affordable detection and treatment of high blood pressure. These strategies help save lives and reduce health care costs. They include:

  • Expanding the use of team-based care, which means health care providers work with pharmacists, community health workers, and other health professionals to manage patients’ high blood pressure.3,7
  • Increasing the use of community health workers to connect people with the services and lifestyle programs they need to reduce their blood pressure.5
  • Increasing the use of self-measured blood pressure monitoring, where people with high blood pressure check their own blood pressure regularly and share this information with their health care provider.6,8

Improvements in high blood pressure control or further reductions in the number of people with high blood pressure could generate billions in health care cost savings every year. For example:

  • Using team-based care that includes a pharmacist could prevent up to 91,900 heart attacks, 139,000 strokes, and 115,400 cardiovascular deaths over 5 years among US adults with uncontrolled high blood pressure. Medicare could save up to $900 million over 5 years with this intervention.7
  • Reducing average population sodium intake to 2,300 mg a day (the recommended maximum for adults) may reduce cases of high blood pressure by 11 million annually, saving $18 billion in health care costs.9

For more information about strategies to prevent heart disease and stroke, see Best Practices for Cardiovascular Disease Prevention Programs and Hypertension Control Change Package for Cliniciansexternal icon.

money

$79 BILLION‡(d)

total annual medical costs associated with high blood pressure4

The High Cost of High Blood Pressure

Because high blood pressure affects so many Americans and is a key risk factor for heart disease and stroke, it is one of our nation’s costliest health conditions.

  • Annual medical costs for people with high blood pressure are up to $2,500‡(d) higher than costs for people without high blood pressure.10,11
  • About 650 million prescriptions for blood pressure medicine are filled each year. This accounts for about $29 billion‡(c) in total spending, of which $3.4 billion is paid directly by patients.12
*
Public health interventions that cost less than $50,000 per QALY are widely considered cost-effective.
Costs measured in a2010 US dollars, b2015 US dollars, c2014 US dollars, d2014 and 2016 US dollars, and e2008 US dollars. Older cost estimates are likely to be underestimates.
References
  1. Centers for Disease Control and Prevention. Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. US Department of Health and Human Services. March 22, 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.htmlexternal icon. Accessed March 22, 2021.
  2. Centers for Disease Control and Prevention. CDC WONDER Online Database website. About Underlying Cause of Death 1999–2017. http://wonder.cdc.gov/ucd-icd10.html. Accessed December 16, 2019.
  3. Guide to Community Preventive Services. Cardiovascular Disease Prevention and Control: Team-Based Care to Improve Blood Pressure Control. http://www.thecommunityguide.org/cvd/teambasedcare.htmlexternal icon. Accessed December 16, 2019.
  4. Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. 2020;323(9):863–884. doi:10.1001/jama.2020.0734
  5. Guide to Community Preventive Services. Cardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers. https://www.thecommunityguide.org/findings/cardiovascular-disease-prevention-and-control-interventions-engaging-community-healthexternal icon. Accessed December 16, 2019.
  6. Guide to Community Preventive Services. Cardiovascular Disease Prevention and Control: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control—When Combined with Additional Support. https://www.thecommunityguide.org/findings/cardiovascular-disease-self-measured-blood-pressure-with-additional-supportexternal icon. Accessed December 16, 2019.
  7. Overwyk KJ, Dehmer SP, Roy K, et al. Modeling the health and budgetary impacts of a team-based hypertension care intervention that includes pharmacists. Med Care. 2019;57(11):882–889.
  8. Arrieta A, Woods J, Qiao N, Jay S. Cost-benefit analysis of home blood pressure monitoring in hypertension diagnosis and treatment: an insurer perspective. Hypertension. 2014;64:891–896.
  9. Polar K, Sturm R. Potential societal savings from reduced sodium consumption in the US adult population. Am J Health Promot. 2009;24(1):49–57.
  10. Wang G, Zhou X, Zhuo X, Zhang P. Annual total medical expenditures associated with hypertension by diabetes status in US adults. Am J Prev Med. 2017;53(6 suppl 2):S182–S189.
  11. Kirkland EB, Heincelman M, Bishu KG, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003–2014. J Am Heart Assoc. 2018;7(11).pii: e008731.
  12. Ritchey M, Tsipas S, Loustalot F, Wozniak G. Use of pharmacy sales data to assess changes in prescription- and payment-related factors that promote adherence to medications commonly used to treat hypertension, 2009 and 2014. PLoS One. 2016;11(7):e0159366.
  13. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933–944.
Page last reviewed: May 10, 2021