Does High Systolic Blood Pressure Truly Increase Medical Expenditure?—An Empirical Analysis of the New 2017 ACC/AHA Hypertension Guideline

Nawata, Kan; Kimura, Masaaki

doi:10.4236/health.2018.108079

Cited by 6 publications

(6 citation statements)

References 41 publications

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“…[38]. However, as shown in a previous study [24], higher LDL values lower the medical costs in both groups. Although the signs of AST are opposite in the diabetic and non-diabetic groups, other variables show similar trends in both groups.…”

Section: Power Transformation In Tobit and Probit Modelssupporting

confidence: 52%

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Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Nawata¹,

Kimura²

2018

Health

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Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline in November 2017. However, previous studies have pointed out that this new guideline might lack sufficient evidence to justify its use. Data and Methods: The effects of blood pressure (BP) on medical costs and on the probability of having heart disease as anamnesis are analyzed. We used a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals obtained from three health insurance societies from April 2013 to March 2016. The dataset was divided into subgroups based on whether the patients had diabetes and took hypertension medications. The power transformation and probit models were used in the study. Results: We observed negative effects of systolic BP (SBP) on medical costs in most subgroups. We could not find evidence that higher SBP made the medical costs and probability of having heart diseases higher. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Conclusion: The results of this study did not support the new 2017 ACC/AHA guideline, at least for SBP. The new guideline must be more carefully reevaluated by additional studies. Limitations: The dataset was observatory, the sample period was only 3 years, and we could not complete a time-series analysis of individuals.

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Section: Power Transformation In Tobit and Probit Modelssupporting

confidence: 52%

“…We used a dataset containing 175,123 cases for which both the results of checkups and medical costs were available in the same fiscal year. For details of the dataset see Nawata and Kimura [24].…”

Section: Datamentioning

confidence: 99%

Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Nawata¹,

Kimura²

2018

Health

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“…Nawata and Kimura [36] [37] evaluated the medical expenditures using a dataset containing 175,123 medical checkup observations and 6,312,125 receipts from 88,211 individuals obtained from April 2013 to March 2016. They could not find evidence that higher SBP made the medical costs and probability of having HD higher.…”

Section: Introductionmentioning

confidence: 99%

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Nawata¹

2021

Health

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Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.

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“…Nawata and Kimura ( 36 ) evaluated the effects of BP on increases in medical costs using the power transformation tobit models and a dataset consisting of 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals obtained from April, 2013 to March 2016. They found a negative relationship between SBP and medical costs.…”

Section: Previous Studiesmentioning

confidence: 99%

Heart diseases, hypertension and effects of antihypertensive medications: Is hypertension a true risk factor of heart diseases?

Nawata

2022

Front. Public Health

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BackgroundHeart diseases (HD) are the leading cause of deaths in the world. Many studies have been done on the relationships among hypertension, HD and antihypertensive medications. Most of the studies find that hypertension is a significant risk factor of HD, but there are some studies in which hypertension is not a risk factor. As antihypertensive medications are routinely prescribed to prevent HD, it is necessary to evaluate the effects of these and other risk factors of HD.Data and methodsThe relationship between hypertension and HD was analyzed using 6,773,464 medical checkups obtained from the JMDC Claims Database obtained from January 2005 to September 2019. Factors potentially affecting HD, including blood pressures (BP) and usage of antihypertensive medications, were evaluated using 2,861,769 observations. To avoid the causality problem, probit models were used to analyze the probability of an individual who had no history of HD at year t developing HD by year t + 1.ResultsA positive relation between systolic blood pressure (SBP) and HD was found in the equation without any other covariates. However, the significant relation between HD and BP disappeared when the models contained various other factors as covariates. When a 10-year age or longer interval was used in the model, a positive relation between the two variables was found, suggesting that SBP works as a proxy variable. Taking antihypertensive medications greatly increases the probability of developing HD in the next year. Higher levels of cholesterols decrease the probability of developing HD.ConclusionUnlike many previous studies, no significant relationship between HD and hypertension was found in the models containing multiple covariates. The accepted relation might actually be spurious, and it is important to select covariates carefully. Taking antihypertensive medications appears to increase the probability of developing HD in the next year, suggesting the need for further research and greater caution in the use of antihypertensive medications.

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Does High Systolic Blood Pressure Truly Increase Medical Expenditure?—An Empirical Analysis of the New 2017 ACC/AHA Hypertension Guideline

Cited by 6 publications

References 41 publications

Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Heart diseases, hypertension and effects of antihypertensive medications: Is hypertension a true risk factor of heart diseases?

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