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Background: Hypertension is a prevalent and costly health condition in China. We sought to estimate the inpatient and outpatient expenditures attributable to hypertension among China’s middle-aged and elderly population.Methods: Data for this study was from the China Health and Retirement Longitudinal Survey (CHARLS) 2011 and 2013, a comprehensive and nationally representative survey of Chinese residents aged 45 and older. We selected our study sample among respondents who had complete information on biomarker blood pressure measures and had not developed hypertension in 2011. Hypertension in 2013 was identified in the following steps: (a) He/she had an average systolic blood pressure of ≥ 140 mmHg, and/or an average diastolic blood pressure of ≥ 90 mmHg and/or (b) He/she was currently taking anti-hypertensive medications. The outcome measures were total inpatient expenditures in the past year and outpatient expenditures in the last month. We used a difference-in-difference approach, by classifying those with hypertension as treatment group, and those without hypertension as control group. A propensity score weighting approach was applied to balance out the population characteristics between the treatment and control groups. Linear regression was used to examine the incremental medical expenditures attributable to hypertension.Results: The final sample contained 7827 observations. For those who developed hypertension between 2011 and 2013, their inpatient expenditure increased faster and on average, the hypertension-attributable inpatient expenditures were¥129.5 ($20.9) per person in a year. When we restricted the sample to those with only positive inpatient expenditures, the incremental expenditure reached ¥1526.2 ($246.2) a year. On average, the hypertension-attributable outpatient expenditures were ¥31.0 ($5) per person each month. When we only considered the sample with positive outpatient expenditures, the incremental outpatient expenditures reached ¥276.1 ($44.5) in a month.Conclusions: Having hypertension was associated with substantially higher medical expenditures for both inpatient and outpatient care services. Given that the prevalence of hypertension among adults aged 45 and older was 33% (180 million) in China), the estimated national medical expenditures attributable to hypertension would be as high as ¥90.3 billion ($14.6 billion) per year.