Background: Hypertension is a major risk factor for cardiovascular and renal diseases, significantly contributing to morbidity and mortality. The COVID-19 pandemic has heightened concerns about the impact of hypertension on severe COVID-19 outcomes. Methods: We conducted a cross-sectional analysis using the 2021 MarketScan Commercial and Health and Productivity Management databases. The study included adults aged 18-64 with continuous employer-sponsored private insurance, excluding those with pregnancy or capitated plans. We compared excess total medical costs, healthcare utilization (including the number of emergency department [ED] visits, inpatient admissions, outpatient visits, and outpatient prescription drugs), and productivity losses and related costs due to sick absences, short-term disability (STD), and long-term disability (LTD) between individuals with and without hypertension, further stratified by COVID-19 diagnosis. Multivariate regression models adjusted for demographics and comorbidities were used to estimate the differences in outcomes. Results: Among 1,612,398 adults aged 18-64 years, 13% had hypertension in 2021. Those with hypertension were older, were less likely to be female or live in urban areas, and exhibited a higher prevalence of comorbidities. The total excess medical costs associated with hypertension were $8723 per patient (95% CI, $8352-$9093), which was significantly higher by $6117 (95% CI, $4780-$7453) among individuals diagnosed with COVID-19. Persons with hypertension had higher health care utilization, including a higher number of ED visits (0.21 per patient; 95% CI, 0.21-0.22), inpatient admissions (0.11; 95% CI, 0.10-0.12), outpatient visits (5.42; 95% CI, 5.36-5.49), and outpatient prescription drugs (10.85; 95% CI, 10.75-10.94). Moreover, they experienced a greater number of sick absences (1.22 days; 95% CI, 1.07-1.36) and STD occurrences (3.68 days; 95% CI, 3.38-3.98) per patient compared to those without hypertension. These trends were further exacerbated among individuals diagnosed with COVID-19. Conclusions: Hypertension markedly increases medical costs, healthcare utilization, and productivity losses, which are further exacerbated by COVID-19. These findings highlight the substantial economic burden of managing hypertension in the context of the COVID-19 pandemic and underscore the importance of targeted interventions.

The authors have declared no competing interest.

This study is not based on a clinical trial.

The authors received no financial support for the research, authorship, and/or publication of this article.

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All data were de-identified, and the study was exempt from review by the Institutional Review Board of the Centers for Disease Control and Prevention.

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The authors cannot share the data publicly due to the data user agreement, but the program codes are available upon request to the corresponding author.