We appreciate Kaplan's comments regarding estimates of cost and prevalence of hypertension treatment in our recent article, "Trends in Pharmacologic Management of Hypertension in the United States."1 We were unaware of the articles by Hilleman et al2 and Sclar et al,3 which appear to have been published after our manuscript was accepted for publication. We are aware of a Swedish study estimating drug costs to be 60% of outpatient costs for hypertension,' but we feel that this figure may represent an underestimation of costs in the United States because Swedish regimens use a larger proportion of less-expensive diuretics and β-blockers and because patients' time and travel were included in the cost estimate. A New Zealand study estimated drug costs to account for 84% of direct health care costs for hypertension treatment,5 which is even higher than the estimate of 70% to 80% used in our article.
Monolio T, Cutler JA, Furberg CD, Psaty BM, Whelton PK, Applegate WB. The Costs of Antihypertensive Therapy-Reply. Arch Intern Med. 1996;156(1):110-111. doi:10.1001/archinte.1996.00440010130019