Increased Healthcare Resource Utilization Among Uncontrolled vs. Controlled Hypertension Population: Findings From the EnligHTN Study
Author(s)
Julián Segura, MD, PhD1, naomi ben dor, PhD2, Terry McCormack, MBBS3, Vivek Bhalla, MD4, Joachim Weil, MD5, Stefan Franzén, PhD6, Jieling Chen, PhD7, Esteban Coto, MD8, Ken L. Chin, PhD9, Jesper N. Bech, MD, PhD10.
1Hospital Universitario 12 de Octubre, Madrid, Spain, 2Nephrology and Hypertension Center, Beilinson Hospital, Petah Tikva, Israel, 3Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, United Kingdom, 4Stanford Hypertension Center, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA, 5Medizinische Klinik II, Sana Kliniken Lübeck GmbH, Lübeck, Germany, 6BioPharmaceuticals Medical Evidence Statistics, AstraZeneca, Mölndal, Sweden, 7Health Economics & Payer Evidence, AstraZeneca, Gaithersburg, MD, USA, 8CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA, 9AstraZeneca, Mölndal, Sweden, 10University Clinic in Nephrology and Hypertension, Aarhus University, Herning, Denmark.
1Hospital Universitario 12 de Octubre, Madrid, Spain, 2Nephrology and Hypertension Center, Beilinson Hospital, Petah Tikva, Israel, 3Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, United Kingdom, 4Stanford Hypertension Center, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA, 5Medizinische Klinik II, Sana Kliniken Lübeck GmbH, Lübeck, Germany, 6BioPharmaceuticals Medical Evidence Statistics, AstraZeneca, Mölndal, Sweden, 7Health Economics & Payer Evidence, AstraZeneca, Gaithersburg, MD, USA, 8CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA, 9AstraZeneca, Mölndal, Sweden, 10University Clinic in Nephrology and Hypertension, Aarhus University, Herning, Denmark.
OBJECTIVES: Uncontrolled hypertension (HTN) remains a major public health concern, requiring increased engagement with healthcare providers and placing a significant burden on the healthcare system. The present analysis aimed to evaluate healthcare resource utilisation (HCRU) by blood pressure control status.
METHODS: In this study, data from the IQVIA Ambulatory EMR linked with IQVIA PharMetrics® Plus claims (US) from 2018 to 2023 were analysed, with additional data anticipated from other countries. Patients diagnosed with HTN who had a blood pressure (BP) measurement while being treated with ≥2 antihypertensive medications for ≥30 days (index date) were included. Uncontrolled BP was defined by an index blood pressure ≥130/80 mmHg in the US (local recommendation). Patients whose BP was below target were considered ‘controlled’. HCRU was assessed using negative binomial models adjusted for baseline patient characteristics and comorbidities through a risk score derived from random forest models.
RESULTS: A total of 322,979 patients were included. In the adjusted models, HCRU was consistently higher among those with uncontrolled HTN compared with controlled HTN. Specifically, the rate of primary care visits was higher in uncontrolled HTN (rate ratio [RR] 1.58, 95% confidence interval [CI] 1.53 to 1.63), as was the rate of visits to nurse practitioners (RR 1.55, 95% CI 1.49 to 1.61), outpatient specialists (RR 1.19, 95% CI 1.16 to 1.21), and psychologists/psychiatrists (RR 8.00, 95% CI 6.62 to 9.65). The hospital admission rate (RR 2.06, 95% CI 1.91 to 2.23) and the mean number of hospital days per person per year (RR 2.75, 95% CI 2.50 to 3.01) were notably higher among individuals with uncontrolled compared to controlled HTN.
CONCLUSIONS: Uncontrolled HTN is associated with a substantial increase in healthcare resource utilization, including a transition from lower- to higher-intensity services when compared with controlled HTN, underscoring an urgent need for effective blood pressure management.
METHODS: In this study, data from the IQVIA Ambulatory EMR linked with IQVIA PharMetrics® Plus claims (US) from 2018 to 2023 were analysed, with additional data anticipated from other countries. Patients diagnosed with HTN who had a blood pressure (BP) measurement while being treated with ≥2 antihypertensive medications for ≥30 days (index date) were included. Uncontrolled BP was defined by an index blood pressure ≥130/80 mmHg in the US (local recommendation). Patients whose BP was below target were considered ‘controlled’. HCRU was assessed using negative binomial models adjusted for baseline patient characteristics and comorbidities through a risk score derived from random forest models.
RESULTS: A total of 322,979 patients were included. In the adjusted models, HCRU was consistently higher among those with uncontrolled HTN compared with controlled HTN. Specifically, the rate of primary care visits was higher in uncontrolled HTN (rate ratio [RR] 1.58, 95% confidence interval [CI] 1.53 to 1.63), as was the rate of visits to nurse practitioners (RR 1.55, 95% CI 1.49 to 1.61), outpatient specialists (RR 1.19, 95% CI 1.16 to 1.21), and psychologists/psychiatrists (RR 8.00, 95% CI 6.62 to 9.65). The hospital admission rate (RR 2.06, 95% CI 1.91 to 2.23) and the mean number of hospital days per person per year (RR 2.75, 95% CI 2.50 to 3.01) were notably higher among individuals with uncontrolled compared to controlled HTN.
CONCLUSIONS: Uncontrolled HTN is associated with a substantial increase in healthcare resource utilization, including a transition from lower- to higher-intensity services when compared with controlled HTN, underscoring an urgent need for effective blood pressure management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE550
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)