Controlling arterial hypertension in the French West Indies: a separate strategy for women?

BACKGROUND: To estimate the prevalence, awareness and treatment of arterial hypertension in Guadeloupe. METHODS: In 2007, a cross-sectional study of 1005 men and women (54%) aged 25-74 years from Guadeloupe, stratified by sex, age and region was set up to determine the prevalence of hypertension. Blood pressure (BP) was measured using an automated device and hypertension was defined as having a mean BP ≥ 140/90 mmHg or receiving drug treatment. RESULTS: The prevalence of hypertension was 33% for men and 37% for women (P = 0.62). Among hypertensive respondents, 57% of men and 80% of women were aware of being hypertensive (P < 0.001). BP was controlled for 22 and 44% of hypertensive men and women, respectively (P < 0.001). Compared with men (14%), 31% of women were obese (≥ 30 kg/m²). In multivariate analyses, body mass index (BMI) was associated with hypertension in both sexes after controlling for age, occupation, education, alcohol consumption, smoking status and physical activity. Compared with subjects with a normal BMI, obese men were three times odds ratio (OR) = 3.4, 95% confidence interval (CI) = 1.8-6.6 P < 0.001 and obese women two times more likely (OR = 2.0, 95% CI = 1.2-3.4, P = 0.017) to be hypertensive. In women, low educational attainment was also associated with hypertension (OR = 2.1 95% CI = 1.1-4.0, P = 0.030) and mean diastolic BP decreased as educational attainment increased after controlling for confounders (F = 5.0, df 2, P = 0.007). CONCLUSIONS: Strong gender disparities in hypertension were identified. Separate strategies in addressing hypertension in men and women are needed, with an improvement in men's follow-up care and health promotion, focussed on nutrition, targeted at women.