Hypertension, a major risk factor for cardiovascular diseases such as stroke and myocardial infarction, affects approximately 50 million adults in the United States. OBJECTIVES: To assess utilization and costs for hypertension-related medical services and pharmacotherapy among recipients in a state Medicaid population. METHODS: Medical services claims with a primary ICD-9 CM diagnosis code for hypertension (401.xx) during calendar year 2002, for recipients between 15 and 64 years of age were extracted. Unique recipient identifiers obtained from these claims were then used to extract hypertension-related prescription claims. Medicaid reimbursements were used to calculate costs for outpatient, ED and prescription use; Medicare DRG average reimbursement amounts were used to calculate hospital costs. RESULTS: Overall hypertension prevalence was 10.7% among Medicaid recipients. Of the 17,610 recipients identified, 25% received single antihypertensive drug therapy, 60% received two or more antihypertensive drugs and 15% had no prescription claims for antihypertensive drugs. Of those recipients receiving single drug therapy (n = 4,478), 30% received angiotensin converting enzyme inhibitors, 22% received beta blockers, 18% received calcium channel blockers, 15% received diuretics, 10% received angiotensin receptor blockers, and 5% received other classes of drugs such as alpha1 blockers, centrally acting alpha2 agonists, and vasodilators. The rates of hospitalization, ED and outpatient visits were 5/10,000 recipients, 43/10,000 recipients, and 173/1,000 recipients, respectively. The mean cost per hospitalization, ED and outpatient visit was $2,422 (SD = $359), $188 (SD = $211) and $58 (SD = $61), respectively. Total hypertension-related expenditures to Medicaid were: $193,776 for hospitalizations, $133,779 for ED use, $2,296,746 for outpatient use and $6,744,515 for prescription drugs. CONCLUSIONS: Results showed that a majority of recipients with hypertension received two or more antihypertensive drugs. Hypertension is responsible for a substantial economic burden to Medicaid with outpatient use accounting for most medical visits and prescription drugs accounting for most dollars.