Economic Burden Of Hypertension Research Articles

Time Series Analysis of the Impact of Meteorological Conditions and Air Quality on the Number of Medical Visits for Hypertension in Haikou City, China

Meteorological conditions and air quality are important environmental factors in the occurrence and development of cardiovascular diseases (CVDs) such as hypertension. The aim of this study was to take Haikou City, located on the tropical edge, as the research area and to analyze the exposure–response relationship and lag effect between its meteorological conditions, air quality, and the number of hypertensive patients. Using the data from the hypertension outpatient department of Hainan Provincial People’s Hospital from 2016 to 2018, together with meteorological data and air quality data, a distributed lag nonlinear model based on the nested generalized addition model of meteorological element base variables was established. The results showed that the impact of temperature on the risk of hypertension was mainly due to the cold effect, which was associated with high risk, with a lag of 1–10 days. When the temperature dropped to 10 °C, the cumulative effect on the risk of hypertension of relative risk (RR) reached its highest value on the day the low temperature occurred (RR was 2.30 and the 95% confidence interval was 1.723~3.061), passing the test with a significance level of 0.05. This result indicated that efforts should be made to strengthen the prevention of hypertension under low-temperature conditions and the prediction and early warning of disease risks. The impact of the air-quality effect (the environmental Air Quality Index was selected as an indicator) on the risk of hypertension was mainly characterized by a low air-quality effect, with a lag effect of 0–8 days. When the risk reached approximately 124, the RR was highest (RR was 1.63 and the 95% confidence interval was 1.104~2.408), passing the test with a significance level of 0.05. The research results can provide technical support for conducting medical meteorological forecasting, early warning, and services for hypertension. A joint work and research mechanism among multiple departments such as meteorology and medical health should be established to improve the level of medical and health care, optimize the allocation of social resources, and develop targeted prevention and control strategies to reduce the health and economic burden of hypertension.

Trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China: two repeated cross-sectional studies

ObjectivesThis study aimed to analyse trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China.DesignTwo repeated cross-sectional studies were conducted to collect interview...

The economic impact of treating hypertension in sub–Saharan Africa - A systematic review

Abstract Background Hypertension is a leading risk factor for cardiovascular diseases, with high numbers of undiagnosed and untreated patients in sub-Saharan Africa (SSA). While the disease poses a substantial social and economic burden for patients and health systems, research on the economic consequences remains scarce. This systematic review compared hypertension treatment costs in SSA and identified possible cost drivers and opportunities to reduce the economic burden. Methods A systematic search was performed in six databases (PubMed, Web of Science, CINAHL, ISPOR, EconLit and Google Scholar) for peer-reviewed articles published in English from inception to Jan. 2022. We included studies assessing the direct or indirect costs of hypertension treatment across SSA. All results were converted to 2021 US Dollars. Results Of 3999 initial articles, 33 were included in the systematic review. Only 12 of 48 SSA countries provided data on the economic burden of hypertension, and results varied according to their perspective and setting. Total treatment costs per patient ranged from monthly 2.70$ for medicine collection visits in Ghana to 46.24$ for emergency visits in Kenya for patients and from 6.52$ in Ghana to 28.19$ in Rwanda for providers. Medication costs had the most significant impact and were the most reported cost item. Treatment in higher-level hospitals and private institutions was considered more expensive. Single or combinative use of angiotensin-converting enzyme inhibitors, calcium channel blockers and diuretics were the cheapest treatment options across SSA. Conclusions Hypertension care poses a significant economic burden for health systems and patients. While the costs were heterogeneous according to measuring and financing methods, medication was identified as the most critical cost factor. Reducing medication costs, supporting patients through subsidies, using generics and cheaper therapy options should be considered. Key messages • Hypertension costs in sub-Saharan Africa are a significant burden mainly driven by medications. • Introducing targeted subsidies, generics, and low-priced therapies could reduce medication costs.

Direct Costs of Hypertension Treatment in Iran.

Hypertension is a common public health problem with potentially serious consequences. We aimed to explore the direct costs of hypertension treatment in Iran. Literature review and STEPS survey were used to estimate the incidence and prevalence of hypertension for Iranian males and females and the proportion of its treatment coverage in 2020. A standard national protocol for hypertension treatment was used to estimate the required medical services including visits, medications, and lab tests. The cost of each service and the total cost of the disease were identified using the national reference costs. About 23.39 million people suffer from moderate systolic blood pressure (BP of 120 to 139 mm/Hg) and a further 14.6 million people had severe BP (≥140 mm/Hg). Nearby 39.8% of these patients, receive BP treatment. The direct costs of hypertension treatment were 19,006.08 billion IR Rials (USD 87.54 million), of which 16.60% and 83.40% of the costs were related to new and prior cases, respectively. The costs of patient visits, medications, and lab tests were 56%, 35.51%, and 8.49% of the total costs, respectively. The prevalence and economic burden of hypertension are relatively high in Iran. Early detection and treatment of hypertension might have a significant effect on reducing its complications and costs.

Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension.

The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.

PS-C19-8: A COMPARISON OF THE MEDICATION COST AND INCIDENCE RATE OF CARDIOVASCULAR EVENTS BETWEEN INTENSIVE AND STANDARD ANTIHYPERTENSIVE PHARMACOTHERAPIES IN JAPAN

Objective: Hypertension is a major health challenge, imposing an enormous economic burden as well as health burden worldwide. In Japan, the economic burden of hypertension and related diseases is estimated to be JPY1.7 trillion (USD 13 billion) per year, around 4% of total healthcare expenditures. This study aimed to compare treatment outcomes and costs between intensive and standard pharmacotherapies, focusing on the types of antihypertensive drugs and prescribing patterns. Design and method: We performed a retrospective cohort study using electronic medical record data obtained from 34 healthcare facilities in Japan. The incidence of cardiovascular events captured via claims data was set to be the outcome measure. Multivariable mixed effects Cox-proportional hazards model was applied to compare the costs and the outcomes from intensive pharmacotherapy arm (i.e., short prescribing interval/expensive drugs) and standard one (i.e., long prescribing interval/low-cost drugs). Results: During 6,013 person-years of follow-up, 74 events were observed. While age at the beginning of treatment had significant impact on the incidence of cardiovascular events [Hazard Ratio, 1.05 (95%CI 1.02 - 1.07); p < 0.001], no associations with cardiovascular events were found for mechanism of drug action (CCB) [1.37, (95%CI 0.839 - 2.24); p = 0.21] and for short prescribing interval (less than 30 days) [1.17 (95%CI 0.695 - 1.98); p = 0.55]. The mean medication costs per day per patient of CCB and ARB were JPY 28.9 and JPY 51.8, respectively. Conclusions: No significant impacts on treatment outcomes were observed for drug type and prescribing interval, although the medication costs of intensive pharmacotherapy arm were more expensive than standard arm.

Hypertension in the South African public healthcare system: a cost-of-illness and burden of disease study

ObjectivesTo quantify the health and economic burden of hypertension in the South African public healthcare system.SettingAll inpatient, outpatient and rehabilitative care received in the national public healthcare system.ParticipantsAdults, aged ≥20...

Economic Burden of Depressive Symptoms Conditions among Middle-Aged and Elderly People with Hypertension in China.

People with hypertension are more prone to incur depressive symptoms, while depressive symptoms have an obvious influence on the healthy functioning, treatment, and management of hypertensive patients. However, there have been limited studies on the association between depression and the economic burden of hypertension. We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) to estimate the additional annual direct and indirect economic burden of depressive symptoms among middle-aged and elderly hypertensive patients with a multivariable regression model. The depressive symptoms were associated with substantial additional direct and indirect economic burden. Compared with non-co-MHDS (non-co-morbid hypertension and depressive symptoms) patients, the direct economic burden of lower co-MHDS (co-morbid hypertension and depressive symptoms) patients and higher co-MHDS patients increased 1887.4 CNY and 5508.4 CNY, respectively. For indirect economic burden, the lower co-MHDS patients increased 331.2 CNY and the higher co-MHDS patients increased 636.8 CNY. Both direct and indirect economic burden were incremental with the aggravation of depressive symptoms. The results showed depressive symptoms increased total healthcare costs by increasing the utilization and expenditure of primary healthcare services. Depressive symptoms also led to economic loss of productivity, especially for agricultural workers. This study highlights the importance of mental healthcare for hypertensive patients.

Productivity burden of hypertension in Japan.

In the present study, we aimed to estimate the impact of hypertension in the working-age Japanese population. We developed life table models to estimate total deaths, years of life lived, and productivity-adjusted life years lived (a newly developed metric for quantifying the burden of acute and chronic health conditions on work productivity) among Japanese individuals with hypertension aged 20-64 years, with simulated follow-up until age 65 years. Data inputs were drawn from local population statistics and published sources. Gross domestic product per person employed, a measure of labor productivity, was used to assign an economic value to each productivity-adjusted life year lived. Outcomes and costs were discounted by 2% annually. In 2017, 26.3 million Japanese individuals aged 20-64 years (37.5%) had hypertension. Of these people, 23.7% were treated and had controlled blood pressure, 23.2% were treated but had uncontrolled blood pressure, and 53.1% were untreated. During the simulated follow-up until age 65 years, 335,342 deaths (28.0% of total deaths), 1.6 million years of life (0.8% of total), 3.1 million productivity-adjusted life years (1.9% of total), and US$242.9 billion or 28.3 trillion Japanese yen of gross domestic product were lost to hypertension. Our findings highlight the considerable economic burden of hypertension in Japan, as well as the importance of effective strategies for hypertension prevention and management, which are likely to deliver a significant return on investment.

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

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.

The Cost of Illness of Hypertension and Associated Factors at the University of Gondar Comprehensive Specialized Hospital Northwest Ethiopia, 2018.

PurposeNon-communicable diseases impose a significant social, economic and health burden. Hypertension, the leading contributor to the global burden of disease and a growing public health problem worldwide, is one of the most serious non-communicable diseases. In Ethiopia, empirical evidence on the economic burden of hypertension is limited. Therefore, this study aimed to measure the cost of hypertension and associated factors at the University of Gondar comprehensive specialized hospital, northwest Ethiopia.Patients and MethodsAn institution-based cross-sectional study was conducted on 442 adult hypertensive patients using a semi-structured questionnaire to estimate the direct and indirect costs of hypertension. The human capital approach was used to calculate indirect costs. A generalized linear model was fitted to identify factors associated with the cost of hypertension at a 95% confidence level and <0.05 p-value.ResultsA total of 442, 56.3% female and 64.3% stage one hypertension patients were included. The total cost of hypertension was ETB 2510.32 ($91.72) ± 2152.80 (78.65) per patient per year; The direct medical and non-medical cost constituted 60.81% and 12.17% of the total cost of hypertension, respectively. Hospitalized (exp(b)=1.87, p<0.001), using multidrug (exp(b)=1.32, p<0.000), high socioeconomic status (exp(b)=1.41,p<0.000), college and above education(exp(b)= 1.35, p<0.016), government employment (exp(b)= 1.30, p<0.012), retirement (exp(b)= 0.71, p< 0.001) and co-morbidity (exp(b)= 1.20, p<0.004) were factors significantly associated with the cost of hypertension.ConclusionThe total cost of illness of hypertension is high, and direct medical cost has the highest component of the total cost of illness. Hospitalization, using multidrug, co-morbidity, attending college and above education, highest socioeconomic status and government employment were factors significantly associated with the high cost of hypertension. Therefore, prevention and early detection of complications and co-morbidity are essential to reduce hospitalization and the number of drugs to reduce the direct medical and indirect costs.

Productivity Burden of Hypertension in Australia.

Hypertension increases the risk of premature death and reduces work productivity. We estimated the burden of hypertension in Australia in terms of productivity lost over the working lifetime of the Australian population. Life table models were used to estimate excess mortality, years of life lost, and productivity-adjusted life years lost among Australians with hypertension and of working age (20 to 69 years), with simulated follow-up until age 70 years. In 2017, an estimated 4.1 million working-age Australians (25.9%) had hypertension, of whom an estimated 21.6% were treated and controlled, 17.0% were treated but uncontrolled, and 61.4% were untreated. With simulated follow-up, over 149 846 excess deaths leading to a loss of over 548 794 years of life were predicted to occur in the hypertension cohort. Hypertension also caused the loss of 609 801 productivity-adjusted life years (2.4%), equating to AUD$137.2 billion in lost gross domestic product over the working lifetime. A 25% reduction in hypertension prevalence, in line with the World Health Organisation Global Action Plan targets, would lead to 155 450 productivity-adjusted life years saved over the working lifetime, whereas the adequate treatment and control of all of those with hypertension would lead to 342 538 productivity-adjusted life years saved. This equates to AUD$34.3 billion and $76.4 billion in gross domestic product retained over the working lifetime of the cohort, respectively. Our findings highlight the considerable economic burden of hypertension in Australia and that effective strategies aimed at the prevention and adequate control of hypertension are likely to pay significant economic dividends for individuals, employers, and governments in the longer term.

The economic burden of hypertension, heart failure, myocardial infarction, and atrial fibrillation in Mexico.

The economic burden of hypertension, heart failure, myocardial infarction, and atrial fibrillation in Mexico.

RESOURCE MAINTENANCE TREATMENT OF ARTERIAL HYPERTENSION IN OUTPATIENT CLINICS

Due to the significant financial costs associated with the management of arterial hypertension (HTN), the optimization of health care resource distribution is required. Objective. To study the resource maintenance treatment of HTN in outpatient clinics. design and methods. The study included two stages. Firstly, we selected a sample of primary HTN patients based on the screening of primary medical records (n = 1766). Secondly, we performed a telephone survey 6 months after the inclusion (n = 1419). Results. Outpatients are characterized by a high frequency of visits to the doctor: 2,9 physician’s counseling, 2,6 cardiologist’s counseling, 0.21 cases of medical emergencies, 0.08 hospitalizations per 1 patient for 6 months on average. Significant use of health care resources was found in the following groups: patients aged 60 years and older, who periodically or regularly measure blood pressure (BP), regularly take antihypertensive therapy (AHT), those who have drug incentives, do not use fixed combinations, with uncontrolled BP, coronary heart disease (СHD), who take 3 or more antihypertensive drugs, who changed or withdrew the recommended AHT. Although achieving target BP is associated with a reduced likelihood of medical emergency calls and outpatient physician’s counseling, there was not difference in the number of hospitalizations between the groups with achieved target BP and the group with uncontrolled HTN. Total direct costs for 6 months composed 9 283,13 rubles per one study participant. Factors associated with a higher total direct costs included age 60 years or older, a high level of self-monitoring of BP, regular intake of AHT, the opportunity of drug incentives, the presence of СHD, uncontrolled HTN, multiple combination antihypertensive therapy (3 drugs and more), no use of fixed combinations, changes or withdrawal of recommended AHT. Conclusions. Our analysis of resource provision and cost-effectiveness of HTN treatment allowed to identify the groups of patients with inappropriate resource expenses. These data demonstrate the need for targeted interventions in order to reduce the economic burden of HTN.

PCV65 - The Economic Burden of Hypertension in Latin America

The economic burden of hypertension (HTN) in the Latin American region has not been previously quantified. This research assessed the economic burden of HTN in Brazil, Chile, Colombia, Ecuador, El Salvador, Mexico, Panama, Peru, Venezuela. To estimate the cost of HTN by country, a prevalence approach was used. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and mortality were based on secondary data sources informed by a targeted literature review including country specific grey literature and data sources. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. HTN was found to affect approximately 86.7 million people (27% of the adult population, average of 54.3 years old) in selected Latin American countries in 2015 leading to significant wellbeing loss, estimated at 2.7 million DALYs, and economic burden, estimated at USD5.3 billion in 2015. Health system expenditures accounted for USD999 million (18%) and productivity costs USD4.3 billion (82%) of the total financial burden of AF. On average, health system expenditure represented 0.03% of total gross domestic product (GDP) across the nine countries with Colombia (0.04%), Ecuador (0.03%), El Salvador (0.08%), Mexico (0.03%) and Panama (0.04%) spending more than the average. Total financial costs averaged 0.12% of GDP. HTN imposes a significant burden to the health system and society in Latin America. Productivity losses account for the majority of the burden of HTN in the region. Prevention and appropriate management of HTN may result in substantial wellbeing benefits and economic savings.

Challenges of the epidemiological and economic burdens associated with hypertension in middle income countries: evidence from Mexico.

BackgroundIn order to identify the challenges resulting from hypertension in a middle income country, this study has developed probabilistic models to determine the epidemiological and economic burden of hypertension in Mexico.MethodsConsidering a population base of 654,701 reported cases of adults with hypertension, we conducted a longitudinal analyses in order to identify the challenges of epidemiological changes and health care costs for hypertension in the Mexican health system. The cost-evaluation method used was based on the instrumentation technique. To estimate the epidemiological changes for 2015–2017, probabilistic models were constructed according to the Box-Jenkins technique.ResultsRegarding changes in expected cases for 2015 vs. 2017, an increase of 12 % is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 23 % increase in financial requirements. The total amount for hypertension in 2016 (US dollars) will be $6306,685,320 Of these, $ 2990,109,035 will be as direct costs and $ 3316,576,285 as indirect costs.ConclusionsIf the risk factors and care models remain as they are currently in the health system, the financial consequences will have a major impact on the out-of-pocket users, following in order of importance, on social security providers and on public assistance providers.

Economic Burden of Drug Therapy in Hypertension Management in a Private Teaching Hospital in Nigeria

Background: Information on economic burden of hypertension is needed for relevant decisions and policies due to escalating cost of disease management. Aims: The study assessed economic burden of pharmacotherapy in hypertension management on the National Health Insurance Scheme (NHIS) of Nigeria and the economies of antihypertensives selection. Study Design: Cross-sectional study. Place and Duration of Study: Out-patient-department of a private teaching hospital located in Lagos, Nigeria over four-month duration in 2011. Methodology: Two hundred and fifty case notes of hypertensive patients were randomly selected. These were assessed for costs of pharmacotherapeutic management of hypertension. Patients’ details such as demographic data, drug regimens and funding status were extracted from the case notes. Drugs’ prices were obtained from the hospital billing guide. Data presentation was by using descriptive statistics. Results: Two hundred and eight (83.2%) of the selected case notes met the study criteria. Diuretics were the most economical at an average monthly cost per prescription of NGN858.6 ($5.51) followed by the beta-blockers at NGN1,101.1 ($7.07) while fixed dose combinations were the costliest at NGN10,425.0 ($66.93). Health Maintenance Organizations (HMOs) having 104 (50.0%) of the cohort as enrollees incurred most of the cost at NGN446, 325.0 ($2,865.47) followed by NHIS 75 (36.0%) at NGN321, 354.0 ($2,063.14). An average monthly cost of antihypertensives per patient was highest for private patients NGN4, 314.47 ($27.69) and least for NHIS NGN4, 284.72 ($27.50). The national cost implication using the least average monthly antihypertensive cost per patient of NGN4,284 .72 ($27.50) for NHIS implies an average of NGN51,416.64 ($330.10) per annum for each patient and a whooping sum in excess of NGN1.054 trillion (over $6.76billion) for over 20 million affected hypertensive patients in Nigeria. Conclusion: Cost burden of hypertension management is high, incurred mostly by HMOs and NHIS. Diuretics were the most economical of all prescribed regimens.

Analysis of association of economic burden of hypertension with tobacco exposure in Luoping county of Yunnan province

To analyze the association between hypertension and tobacco exposure Luoping county of Yunnan province and estimate the direct cost attributable to hypertension . Using Probability proportional to size (PPS) sampling method, 5000 rural residents aged over 18 years were selected from 12 townships in Luoping county, Yunnan province in April 2011, from which 4611 subjects completed the survey. Self-designed questionnaires were used to collect general information, smoking status, costs for outpatient consultation, inpatient, treatment, medication, travel, accommodation and extra-nutrition caused by hypertension as well as the information of health-related behavior. Their height, weight, waist circumference, hip circumference and blood pressure were measured. The direct economic burden of hypertension was calculated. Chi-square (χ(2)) test was used to compare gender differences of hypertension prevalence, smoking and passive smoking. And t test was used to compare the differences of direct economic burden of hypertension among different gender, smoking and passive smoking status. Multivariable logistic regression model was used to analyze the influence factors of hypertension. Among the 4611 subjects, the age was (46.90 ± 16.74) years old. Male accounted for 49.8% (2294/4611) and female 50.2% (2317/4611) . The smoking rate was higher in males (75.7% (1736/2294)) than in females(1.6% (38/2317)) (χ(2) = 2669.21, P < 0.01). The passive smoking rate was lower in males (10.0% (230/2294)) than in females (46.2% (1070/2317)) (χ(2) = 744.27, P < 0.05). Non-tobacco exposure rate in males (14.3% (328/1537)) was lower than in females (52.2% (1209/1537)) (χ(2) = 744.37, P < 0.05) . The risk of hypertension in smokers and passive smokers were higher than those without tobacco exposure, OR (95%CI) was 1.41 (1.15-1.71) (P < 0.05) and 1.31 (1.07-1.63) (P < 0.05) respectively. The per capita direct cost of hypertension was (3444.09 ± 3067.83) Yuan. Of this, tobacco exposure (4552.46 ± 3189.05) Yuan was higher than non-tobacco exposure (1907.71 ± 1383.94) Yuan (t = -3.81, P < 0.05) . Moreover, smokers were (6951.71 ± 3422.87) Yuan higher than passive smokers (3128.09 ± 2083.17) Yuan (t = 3.19, P < 0.05) and males (5827.39 ± 3240.50) Yuan were higher than females (2633.03 ± 2569.01) Yuan (t = 3.22, P < 0.05) . The total direct costs of hypertension attributable to smoking and SHS was 41 million and 38 million, respectively. Both smoking and SHS had significant impact on prevalence and economic burden of hypertension in Luoping county. Implementing effective strategies to control tobacco exposure is useful to reduce the economic burden of hypertension in the study region.

Auricular acupuncture for prehypertension and stage 1 hypertension: study protocol for a pilot multicentre randomised controlled trial.

BackgroundHypertension, a worldwide public health problem, is a major risk factor for cardiovascular and kidney disease, and the medical and economic burden of hypertension is increasing. Auricular acupuncture has been used to treat various diseases, including hypertension. Several studies have shown that auricular acupuncture treatment decreases blood pressure in patients with hypertension; however, the scientific evidence is still insufficient. Therefore, we aimed to perform a randomised controlled clinical trial in patients with prehypertension and stage 1 hypertension to evaluate the effect and safety of auricular acupuncture.Methods/designsThis on-going study is a two parallel arm, assessor-blinded, randomised controlled trial. Sixty participants with prehypertension and stage 1 hypertension will be recruited and randomly allocated into two groups in a 1:1 ratio. Participants in the auricular acupuncture group will receive auricular acupuncture treatment two times per week for 4 weeks. Participants in the usual care group will not receive any acupuncture treatment during the study period. All participants in both groups will be provided with verbal and written educational materials regarding the dietary and physical activity habits for controlling high blood pressure, and they will self-manage their lifestyle, including diet and exercise, during the study. The primary outcome is the 24-h average systolic and diastolic blood pressure, as measured with an ambulatory monitor. The secondary outcomes are the mean change in the average systolic and diastolic blood pressure during day- and night-time, the circadian rhythm of blood pressure, the mean arterial pressure, the change in blood pressure before and after auricular acupuncture treatment, the EuroQOL-5D (EQ-5D), heart rate variability (HRV), body mass index (BMI) and laboratory examination, including lipid profile and high sensitivity C-reactive protein (hs-CRP). Safety will be assessed at every visit.DiscussionThis pilot multicentre randomised controlled trial will explore the feasibility of further auricular acupuncture research and provide important clinical evidence for the effect and safety of auricular acupuncture on blood pressure in patients with prehypertension and stage 1 hypertension compared with usual care.Trial registrationClinical Research Information Service: KCT0000169

Les recommandations et le guide « Affections de longue durée » dans l’hypertension artérielle sévère

Severe hypertension is a major cardiovascular and cerebrovascular risk factor and places the patient in the category of high cardiovascular risk, independently of any other cardiovascular risk factors. The economic burden of hypertension is high, with severe hypertension the 4th most costly disease (5.5 billion Euros) on the French list of chronic diseases ("Affections de longue durée" or ALD) for which the national health insurance funds reimburse 100% of expenses. The French High Health Authority recently suggested removing hypertension from the ALD list. This recommendation, however, had no scientific rationale but was motivated instead by economic and political factors and may endanger the quality of management of hypertensive patients. The previous ALD criteria for severe hypertension require revision to bring them into line with the recommendations of professional and learned societies. The ALD list should include severe hypertension as well as complicated and treatment-resistant hypertension, with the diagnosis documented by ambulatory or self blood pressure monitoring.