Increased Healthcare Resource Utilisation Among Uncontrolled Versus Controlled Hypertension Patients in China: The Enlightn Study

Objective: Uncontrolled hypertension (HTN) represents a major public health concern, requiring increased engagement with healthcare providers and placing a significant burden on the healthcare system. The present analysis aimed to investigate differences in healthcare resource utilisation (HCRU) according to blood pressure control status in a Chinese population. Design and method: Patients in Tianjin, China with a diagnosis of HTN treated with >=2 antihypertensive drugs between 2018 to 2023 were identified using regional electronic health record data. Patients were considered uncontrolled if their first blood pressure (BP) measurement while treated with >=2 antihypertensive drugs for at least 28 days (index date) was above 130/80mmHg for patients aged <80 years old and above 140/90 mmHg for patients aged >=80 years old. All-cause related HCRU was assessed using negative binomial models adjusted for baseline patient characteristics and comorbidities through a risk score derived from random forest models. Results: A total of 11,538 patients (uncontrolled HTN n=6,932; controlled HTN n=4,606) were included. In adjusted models, HCRU was generally higher among patients with uncontrolled compared with controlled HTN. Specifically, the rate (per-patient-per-year) of any outpatient specialist appointments was higher in patients with uncontrolled HTN (rate ratio [RR]: 1.08, 95% confidence interval [CI]: 1.05, 1.12). Breaking this down by specialty, patients with uncontrolled HTN had higher rates of nephrology (RR: 2.32, 95% CI: 1.89, 2.84) and endocrinology appointments (RR: 1.15, 95% CI: 1.02, 1.29) compared to patients with controlled HTN. The hospital admission rate (RR: 1.24, 95% CI: 1.17, 1.32) was also higher among patients with uncontrolled compared to controlled HTN. Together, these contributed to a higher attendance at the more specialised Tier III hospitals in patients with uncontrolled versus controlled HTN (RR: 1.12, 95% CI: 1.07, 1.18). Conclusions: In this large metropolitan region in Northern China, uncontrolled HTN is associated with increased HCRU, including a greater utilisation of more specialised services, when compared with controlled HTN. These findings highlight the urgent need for more effective blood pressure management.