OBJECTIVES: Regular physical activity is a critical guideline-recommended component of disease management in all patients with hypertension. We examined the associations of health care expenditure and resource use with physical inactivity in this population. METHODS: We used a nationally-representative sample from the 2006 Agency for Healthcare Research and Quality Medical Expenditure Panel Survey(MEPS) for this retrospective study of adults (18 years or older) with a diagnosis of primary hypertension (ICD-9:401.x). Generalized linear modeling was used to assess all-cause total and out-of-pocket health care expenses and the odds of emergency room visits and hospitalizations using gamma and binomial families, respectively, as a function of physical inactivity (self-report of not spending ≥30 minutes in moderate physical activity ≥3 times per week). National population estimates were adjusted for demographics (age, gender, race, education, marital-status, income, region), payer (% coverage by public and/or private insurance), comorbidity severity (Deyo-Charlson index), complicating conditions (depression, diabetes, myocardial infarction, cerebrovascular accidents, heart failure, peripheral vascular disease), and antihypertensive treatment (classes). RESULTS: (reported as weighted estimates±standard errors) Mean age (n=46,884,259) was 60.8±0.3 years; 23.4±0.7% of patients had diabetes, and 13.9±0.5% had depression. Some 52.8±0.9% of patients reported being physically inactive. On average, patients had $8468±257 in total, and $1453±47 in out-of-pocket health care expenses in 2006 with 19.4±0.6% having an emergency room visit and 16.0±0.6% being hospitalized. Physical inactivity was associated with 26.0±6.7% greater total and 18.5±5.4% greater out-of-pocket health care expenses (both p<0.00001). Physical inactivity also was associated with a 23.9±12.4% increase in the odds of an emergency room visit (p=0.032) and a 38.4±15.2% increase in the odds of a hospitalization (p=.003). CONCLUSIONS: We found strong associations between physical inactivity and greater health care expenditures and health care resource use in patients with hypertension. Further research is warranted to identify amenable barriers to physical activity in this population.