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Effective Health Care Program

Data Points #8: Utilization of antihypertensive drug classes among Medicare beneficiaries with hypertension, 2007 to 2009

Research Report

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Note: This report is greater than 5 years old. Findings may be used for research purposes but should not be considered current.

This report is from AHRQ's Data Points Publication Series.

Overview

Between 2007 and 2009, 87 to 88 percent of Medicare beneficiaries with hypertension used at least one prescription for an antihypertensive drug.

Beneficiaries with hypertension used on average 1.9 ± 1.3 antihypertensive drug classes within a calendar year.

The top three dispensed antihypertensive drug classes were beta blockers, diuretics, and angiotensin-converting enzyme inhibitors.

In 2009, the total drug cost for antihypertensive agents was $4.3 billion and the out-of-pocket expenditure was $2.2 billion.

Hypertension is a chronic medical condition in which systemic arterial blood pressure is elevated. Thus, it is more colloquially referred to as high blood pressure. It typically results in thickening and loss of elasticity in arterial walls, as well as hypertrophy of the left heart ventricle. Hypertension is a risk factor for numerous pathologic conditions, including heart attack, heart failure, and stroke. Hypertension is a serious public health challenge in the United States, as it affects approximately 30 percent of adults. Among adults age 60 and above, prevalence exceeds 60 percent. In all, according to the American Heart Association, more than 74 million American adults have hypertension.

The Seventh Report of the Joint Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that treatment of hypertension start with lifestyle modifications. If blood pressure control is not achieved with lifestyle modifications, thiazide diuretics should be used as initial therapy for most patients, either alone or in combination with one of four other antihypertensive drug classes (i.e., angiotensin-converting enzyme inhibitors [ACEIs], angiotensin II receptor antagonists [ARBs], beta-adrenergic blockers [BBs], or calcium channel blockers [CCBs]). Most patients with hypertension will require two or more antihypertensive drugs to control their blood pressure.

Considerable effort has been devoted to increasing awareness and treatment of hypertension among Americans. During 1976–1980, only 51 percent of hypertensive patients ages 18–74 years were aware of their hypertension. This markedly improved during 1999–2000, when 70 percent of people in this age group recognized their hypertension. Between 1976–1980 and 1999–2000, the percentage of patients with hypertension receiving treatment increased from 31 to 58 percent. These changes were associated with reductions in the morbidity and mortality attributed to hypertension during this period.4 However, the U.S. Department of Health and Human Services' goal for 50 percent of Americans with hypertension to have their blood pressure controlled by the year 2000 was not reached.

Hypertension control rates have been shown to be the lowest among individuals age 60 years and above, despite the availability of public/government-provided health insurance for those age 65 years and older.

In addition, data from the Medicare Current Beneficiary Survey Cost and Utilization files showed that 72 percent of Medicare beneficiaries filled at least one antihypertensive prescription during 1995, while Medicare fee-for-service beneficiaries spent an average of $508 on medications during the same year.

This Data Points brief explores the prevalence of hypertension and utilization of antihypertensive drugs among hypertensive Medicare fee-for-service beneficiaries from 2007 to 2009. Further, it examines costs of antihypertensive drugs.

Additional Tables

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