Opportunities for improving the cost-effectiveness of antihypertensive treatment.

Hypertension is an extremely important public health problem, both medically and economically. The cost burden of treatment may significantly compromise care for the individual patient, while in aggregate the direct costs of antihypertensive treatment in the United States approach $8 billion a year. Improved insurance coverage and efforts to control the costs of antihypertensive treatment are needed. Efforts to reduce the costs of care, with minimal or no reduction in its quality, should focus on the following: limiting treatment to patients with sustained diastolic hypertension; improving the efficiency of the delivery process; and emphasizing "low-cost prescribing strategies." The uncertainty that remains over the risk-benefit ratio of pharmacologic treatment for patients with very mild hypertension (90 to 94 mm Hg diastolic) raises additional questions. Even if treatment of mild hypertension is effective, it is without doubt less cost-effective than treatment of moderate and severe hypertension. Is this cost worthwhile? Such trade-offs of cost and benefits will increasingly have to be confronted in the face of limited health care resources.