What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=2105). Intervention: Antihypertensive therapy. Primary outcome: Prevalence of hypertension.

February 24, 2020Open Access

Patterns of hypertension management in France in 2015: The ESTEBAN survey

Key Result

In a representative sample of French adults aged 18-74 years, the prevalence of hypertension was 31.3%, with only 48.9% of hypertensive adults treated and 24.3% achieving blood pressure control.

Study Design

Type

Cross-Sectional (n=2,105)

Multicenter

Yes

Structured PICO

Population

Representative sample of French adults aged 18-74 years

Outcome

Prevalence of hypertension, therapeutic control, and adherence to drug treatment

Despite high awareness, hypertension control and medication adherence remain poor in France, highlighting the need for improved clinical management.

Limitations

The study population was limited to adults aged 18-74.
The sample size was rather small, limiting the statistical power of the analyses.
The prevalence of hypertension was overestimated due to the protocol used (3 measures during a single visit), which is affected by the white coat phenomenon.
Adherence to antihypertensive drugs was assessed by the number of drug boxes purchased during the year, which may overestimate actual adherence.

Abstract

The purposes of this study were to describe the hypertensive population and therapeutic management of hypertension in adults between 18 and 74 years of age in France in 2015. Esteban survey is a cross-sectional survey with a clinical examination conducted in a representative sample of French adults aged 18-74 years between 2014 and 2016. Esteban was entirely public-funded. Blood pressure (BP) was measured during clinical examination with a standardized protocol, and pharmacological treatment was collected through the exhaustive Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP (SBP)> 140 mm Hg, diastolic BP (DBP)> 90 mm Hg or treatment with BP-lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP < 140 mm Hg and DBP < 90 mm Hg. Adherence to drug treatment was defined as more than 80% of days covered by BP-lowering drug per year. The prevalence of hypertension was 31.3%. 74.7% of aware hypertensive participants taking an antihypertensive drug, and 57.7% of them were treated with a single antihypertensive pharmacological class. Overall, among hypertensives, 24.3% had a satisfactory BP control. Only 49.7% of treated hypertensives participants were controlled, and 33.6% of them were adherent to their drug treatment. The prevalence of hypertension in France remains high, with only 74.7% of the aware hypertensive participants receiving pharmacological therapy and only 48.9% of aware hypertensives with a BP at goal. More effective measures are needed to improve clinical management of hypertension in France.

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