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The global cost of nonoptimal blood pressure

Gaziano, Thomas Aa,b; Bitton, Asafc; Anand, Shuchic; Weinstein, Milton Cbfor the International Society of Hypertension

doi: 10.1097/HJH.0b013e32832a9ba3
Original papers: Therapeutic aspects

Objective Suboptimal blood pressure including established nonoptimal blood pressure has been shown to have significant economic consequences in developed countries. However, no exhaustive study has been done to evaluate its potential costs, globally. We, therefore, set out to estimate the global economic cost of nonoptimal blood pressure.

Methods Estimates for healthcare costs attributed to suboptimal blood pressure for those over the age of 30 were made for all the World Bank regions. Annual and 10-year estimates using Markov models were made for the cost of treating nonoptimal blood pressure and its main sequelae: stroke and myocardial infarction.

Results Suboptimal blood pressure cost US$370 000 000 000 globally in 2001. This represents about 10% of the world's overall healthcare expenditures. In the Eastern Europe and Central Asia region, high blood pressure consumed 25% of all health expenditures. Over a 10-year period, elevated blood pressure may cost nearly $1 000 000 000 000 globally in health spending, if current blood pressure levels persist. Indirect costs could be as high as $3 600 000 000 000 annually.

Conclusion Suboptimal blood pressure is responsible for a large and an increasing economic and health burden in developing countries. Although the majority of the current absolute expenditure occurs in the high-income countries, an ever-increasing proportion of the cost is going to be carried by developing countries.

aDivision of Cardiovascular Medicine, Brigham and Women's Hospital, USA

bHarvard School of Public Health, USA

cDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Received 23 September, 2008

Revised 9 February, 2009

Accepted 19 February, 2009

Correspondence to Thomas A. Gaziano, MD, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Tel: +1 617 432 4348; fax: +1 617 432 0190; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.