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World J Cardiol. Jul 26, 2014; 6(7): 531-538
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.531
Hypertension and medical expenditure in the Japanese population: Review of prospective studies
Koshi Nakamura, Tomonori Okamura, Katsuyuki Miura, Akira Okayama
Koshi Nakamura, Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan
Tomonori Okamura, Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo 160-8582, Japan
Katsuyuki Miura, Department of Public Health, and Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga 520-2192, Japan
Akira Okayama, Research Institute of Strategy for Prevention, Tokyo 101-0061, Japan
Author contributions: Nakamura K conceived of this review and drafted the manuscript; Okamura T, Miura K and Okayama A reviewed the manuscript and made the final corrections before submission; all authors read and approved the final version.
Correspondence to: Koshi Nakamura, MD, PhD, Department of Epidemiology and Public Health, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. knaka@kanazawa-med.ac.jp
Telephone: +81-76-2188093 Fax: +81-76-2863728
Received: December 20, 2013
Revised: February 11, 2014
Accepted: May 16, 2014
Published online: July 26, 2014
Processing time: 243 Days and 6.3 Hours
Abstract

Hypertension is a major determinant of health and is likely to have an effect on medical economics. The economic burden due to hypertension may be attributable not only to antihypertensive medication but also to the very expensive procedures required for cases of cardiovascular disease that occur more frequently in hypertensive compared with normotensive individuals. The objective of this article was to review articles published on prospective cohort studies that measured medical expenditure attributable to hypertension in community-dwelling populations in Japan. Many medical services in these populations are provided under the medical insurance system that requires the enrolment of all Japanese residents. Personal medical expenditure attributable to hypertension increases with worsening severity of the condition. Medical expenditure was increased further in cases of hypertensive patients who have another concomitant cardiovascular risk factor. In particular, hypertension, especially moderate-to-severe untreated hypertension, increases the risk of long-term hospitalization resulting in considerably higher medical expenditure, compared with non-hospitalized cases. Therefore, assuming that the use of antihypertensive medication is essential for hypertensive patients to prevent serious vascular diseases, a cost-effective high-risk strategy needs to be considered to reduce both ill-health and the economic burden due to hypertension. However, from a population perspective, medical expenditure attributable to hypertension comes mainly from pre-to-mild hypertension. Therefore, there is also a need to consider a population strategy that aims to shift the entire population to lower levels of blood pressure.

Keywords: Hypertension; Medical expenditure; Japan; Cohort study

Core tip: Hypertension is likely to affect medical economics. We reviewed articles published on prospective cohort studies that measured medical expenditure attributable to hypertension in community-dwelling populations in Japan. Personal medical expenditure attributable to hypertension increased with worsening severity of the condition. Medical expenditure was increased further in hypertensive patients who had another concomitant cardiovascular risk factor. In particular, hypertension, especially moderate-to-severe untreated hypertension, increased the risk of long-term hospitalization. This resulted in considerably higher medical expenditure, compared with non-hospitalized cases. However, from a population perspective, medical expenditure attributable to hypertension is mainly from pre-to-mild hypertension.