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Insurance status influences access to antihypertensive drug therapy, while personal factors influence patterns of use

Hypertension, a potent risk factor for heart attack and stroke, affects more than 50 million people in the United States and more than half of the elderly. Lifestyle changes, such as losing weight, increasing exercise, smoking cessation, and reducing use of salt and alcohol are usually tried before expensive antihypertension medications. When these measures are not enough, patients usually need medication to control their blood pressure.

A person's insurance status has a striking effect on their access to antihypertensive drugs. Race/ethnicity and attitudes toward risk also influence access to drug therapy, as well as patterns of drug use and expenditures, according to a study supported by the Agency for Healthcare Research and Quality (HS09538).

AHRQ researcher, John F. Moeller, Ph.D., and his colleagues used data from the 1987 National Medical Expenditure Survey to identify 6,398 adults with hypertension as well as patient self-reports about use of antihypertensive medications to detect factors affecting patterns of drug use and expenditures. They found that privately insured patients were 59 percent (if non-elderly) or 163 percent (if elderly with Medicare) more likely to receive drug therapy than uninsured patients. Patients with Medicaid coverage were 126 percent more likely to receive drug therapy than uninsured patients.

Women and the elderly were more likely to obtain medications and spent more on them. Compared with patients characterized as low risk-takers, very high and high risk-takers were 38 percent and 24 percent less likely to be on antihypertensive therapy, respectively. Blacks were 30 percent more likely to be on drug therapy than whites, but they had lower annual expenditures for antihypertensive drugs. Minorities are either given different treatments or are more price-sensitive, given their lower insurance coverage. Severely overweight individuals were 62 percent more likely than patients of normal weight to be on drug therapy and also spent more on antihypertensives, either due to more prescriptions or more costly drug therapies.

See "Patterns and costs for hypertension treatment in the United States," by Christine Huttin, Dr. Moeller, and Randall S. Stafford, in the September 2000 Clinical Drug Investigations 20(3), pp. 181-195.

Reprints (AHRQ Publication No. 01-R003) are available from the AHRQ Publications Clearinghouse.

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