Introduction: In low-income countries, the predominance of out-of-pocket payments constitutes a major barrier to equitable access to care for chronic diseases such as hypertension. This study aims to analyze the structure and determinants of the annual direct cost of hypertension care at the Atacora Departmental Hospital Centre (CHD) in northern Benin. Methods: An analytical cross-sectional study was conducted from July to December 2024 among 295 hypertensive patients followed at the CHD Atacora in northern Benin. Direct costs (consultations, medications, biological and radiological exams, transport, and incidentals) were estimated and aggregated for each patient. The annual cost was dichotomized around the median. The determinants of a high cost were identified using multivariate logistic regression with a 5% significance level. Results: The median annual direct cost of care was $180.5 (Q1: $100.8; Q3: $268.3). This cost is dominated by medication costs (median = $140.0; Q1: $60.0 and Q3: $211.0) and the cost of biological tests (median: $16.7; Q1: $5.0 and Q3: $41.7). The components of the direct cost, especially medications and biological tests, are increasingly higher when income exceeds $166.7. The determinants of a high direct cost were: occupation as a manual laborer (OR = 2.14; 95% CI = 1.01 - 4.51; p = 0.045); tradesperson (OR = 3.65; 95% CI = 1.76 - 7.55; p = 0.000); income of [$166.7 - $416.7[ (OR = 3.13; 95% CI = 1.26 - 7.81; p = 0.014); income ≥ $416.7 (OR = 3.34; 95% CI = 1.25 - 8.89; p = 0.015); good treatment adherence (OR = 1.97; 95% CI = 1.17 - 3.31; p = 0.010); and knowledge of cardiovascular risks (OR = 1.99; 95% CI = 1.18 - 3.34; p = 0.009). Conclusion: These results, which reveal the importance of socioeconomic factors in the care of hypertensive patients, argue for the strengthening of financial protection mechanisms, health education, and increased access to essential medicines in order to reduce the financial vulnerability of hypertensive patients.
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