Nationwide Healthcare Expenditures among Hypertensive Individuals with Stroke: 2003-2014 Alain Lekoubou, MD,* Kinfe G. Bishu, PhD,† , ‡ and Bruce Ovbiagele, MD, MSc, MAS, MBA* Background: Of all the various clinical entities, hypertension is arguably most strongly linked to the occurrence of stroke. However, the impact of stroke on health-care expenditures in patients with hypertension has not been previously evaluated. Methods: We analyzed data from the Medical Expenditure Panel Survey House- hold Component, 2003-2014 data. Adults aged 18 years or greater were included in this analysis. We used a 2-part model (adjusting for demographic, comorbidity, and time) to estimate the incremental health-care expenditures incurred by stroke among individuals with hypertension. Results: On average, $4057 more dollars (adjusted incremental health-care expenditure) was spent on individuals with hy- pertension plus stroke versus no history of stroke. Overall unadjusted mean medical expenditure in those with a comorbid diagnosis of stroke was twice as high as in those without a diagnosis of stroke ($16,668 versus 8374; P < .001). Inpatient expenditures (37.4%), outpatient expenditures, and prescription expenditures (nearly 23% each) accounted for almost 80% of the total mean unadjusted direct expen- ditures. Annual average unadjusted aggregate costs among individuals with hypertension and stroke were $98.3 billion, while annual adjusted aggregate in- cremental costs were higher by $24 billion among patients with stroke versus those without stroke. Conclusion: Among individuals with hypertension in the United States, those who have experienced a stroke incur tens of billions of dollars in higher health-care expenditures compared with those without known stroke. Greater emphasis on stroke prevention strategies and cost control initiatives (wherever appropriate) are warranted. Key Words: Hypertension—stroke—health-care expenditure—nonstroke—nationwide. © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. From the *Department of Neurology; †Department of Medicine; and ‡Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, South Carolina. Received October 30, 2017; revision received January 27, 2018; accepted February 3, 2018. Author contributions: Dr. Lekoubou: Study concept and design, data interpretation, and critical revision of the manuscript for important intellectual content. Dr. Bishu: Study concept and design, statistical analysis and data interpretation, and critical revision of the manuscript for important in- tellectual content. Dr. Ovbiagele: Study concept and design, critical revision of the manuscript for important intellectual content, and study supervision. Address correspondence to Alain Lekoubou, MD, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, suite 301, Charleston, SC 29425. E-mail: lekoubou@musc.edu. 1052-3057/$ - see front matter © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.003 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2018: pp ■■–■■ 1