Financial cost as an obstacle to hypertension therapy.

Shulman, Neil; Martinez, Belkis Y.; Brogan, Donna; Carr, Albert A.; Miles, Charles P.

doi:10.2105/ajph.76.9.1105

Cited by 112 publications

(32 citation statements)

References 18 publications

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“…23 Although patients rarely cite cost as a reason for failure to take medication or keep appointments, cost appears to be a more frequent barrier to effective therapy than is generally appreciated. 13,49 In this study, the surprisingly few patients that cited costs of antihypertensive medications and physician care as a barrier may be unique to our facility and some other public hospitals. Our hospital has a liberal sliding scale policy such that approximately 40% of all patients have no copayment or no charge for medications and physician visits at the hospital.…”

Section: Discussionmentioning

confidence: 96%

“…11 In addition to being more prevalent and more severe, hypertension in minority populations has more serious consequences. 12,13 Compared with U.S. whites, African Americans have an increased risk of cardiovascular mortality, end-stage renal disease, and stroke. 11,12,14 One of the national health objectives for the year 2000 is to increase the rate of patients with controlled BP to at least 50%.…”

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confidence: 99%

“…24,25 However, these studies do not provide data on the relationship between source of care or insurance status (Medicaid vs private insurance) and the level of BP control in patients in an outpatient setting. In addition, even though data indicate that the cost of antihypertensive medications and physician visits is a problem, 13,23,[26][27][28] this cost has not been linked to the level of BP control. With regard to insurance, many studies have suggested a stepwise differential in access to care, receipt of medical care, and health-related outcomes, with private insurance being better than Medicaid, which in turn is better than no insurance.…”

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confidence: 99%

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Correlates of Controlled Hypertension in Indigent, Inner-City Hypertensive Patients

1997

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OBJECTIVE:To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients. DESIGN:Case-control study. SETTING: Urban, public hospital.PATIENTS: A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) Յ 140 mm Hg and diastolic blood pressure (DBP) Յ 90 mm Hg, and case patients had a SBP Ն 180 mm Hg or DBP Ն 110 mm Hg. 96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician. MEASUREMENTS AND MAIN RESULTS: CONCLUSIONS:The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.KEY WORDS: inner-city patients; hypertension; access to care; regular source of care.

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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Correlates of Controlled Hypertension in Indigent, Inner-City Hypertensive Patients

1997

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“…47,48 Studies of patients with hypertensive emergencies 49 and severe uncontrolled hypertension 50 found that almost all of these hypertensive persons had been previously treated. Lack of access to primary care 50 and financial barriers 51 are key problems for uninsured or underinsured groups and groups with large out-of-pocket costs for medications, although other studies have found low rates of hypertension control even in fully insured healthcare workers. 52 The findings in this large autopsy series underscore the importance of hypertension in the excess cardiovascular mortality experienced by blacks in the United States.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Vascular Disease as a Cause of Death in Blacks Versus Whites

Onwuanyi

Hodges²,

Avancha³

et al. 1998

Hypertension

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Abstract-Cardiovascular disease is the major cause of excess mortality among urban US blacks, but autopsy data comparing black-white differences in underlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Medical Examiner's Office in which the coded cause of death was cardiovascular disease (International Classification of Diseases, 9th Revision, codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missing or coded as other than black or white, gender was not coded, or there was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjects. Black women were younger than white women at time of death (mean age, 54.7 versus 61.5 years; PϽ.001), whereas black and white men did not differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (PϽ.001). Conversely, atherosclerotic heart disease was the autopsy cause of death in 64% of white subjects but only 38% of blacks. These patterns were consistent in both sexes and after adjustment for age. Hypertensive vascular disease was far more common than atherosclerotic heart disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was more common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks. (Hypertension. 1998;31:1070-1076.)

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“…6 There are certainly many reasons older patients are not adequately treated, including access to care, cost of medications and drug-related side effects. [7][8][9] Evidence also suggests that medication intolerability can contribute to drug discontinuations. 10 The angiotensin II receptor blocker, losartan, is indicated for the treatment of essential hypertension.…”

Section: Introductionmentioning

confidence: 99%