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High blood pressure is one of our most severe public health problems, and any national health policy must take account of the dilemmas posed by hypertension. This disease is widespread in the United States, affecting between 10 and 30 percent of the adult population. Of the 24 million Americans so afflicted, only about three million are thought to be adequately treated; yet treatment of all hypertensives would cost perhaps five billion dollars a year.
In their ground-breaking study, Weinstein and Stason apply the tools of cost–benefit analysis to examine the policy implications of existing approaches to hypertension. Their conclusions have important consequences for allocating the resources available to combat the disease, and they identify the salient questions to be answered by new research. The authors’ recommendations would lead to significant changes in current approaches (the much-publicized effort to screen for new cases, for instance). They suggest that criteria for case-finding and treatment be radically altered to take account of differences in the complications of high blood pressure as a function of age, sex, and race. They stress patient compliance as the single most important factor in reducing deaths—considerably more important right now than screening. Their research priorities include: determining the extent to which early or mild hypertension affects the rate of complication; pinning down the role that side-effects of medication play in the demonstrably poor adherence of patients to treatment; and developing alternative programs to improve patient adherence.