Severe high blood pressure in France: Treatment and blood pressure control in 1999 and 2003

Aim: As part of its long-term program (1999-2003) of health initiatives, the French health fund conducted two studies concerning patients with high blood pressure (HBP). The aim was to analyze the overall-care, treatment and blood pressure control obtained with respect to the 1997 ANAES guidelines and to measure the evolution between the beginning and the end of the program. Method: We performed two retrospective observational studies over the entire French territory in 1999 and 2003 on two samples of patients between the ages of 20 and 80 years who were enrolled when they first obtained exemption from making co-payments for their long-term illness, HBP. Study data was collected from the health fund’s salaried physician-advisors following the clinical examination of the patients and from information contained in the patient files of the corresponding attending physicians. The main parameter studied was blood pressure control which was assessed by using the average of the last three systolic (SBP) and diastolic (DBP) blood pressure measurements recorded by the patients’ attending physicians. Results: The first study (from May 1999 to November 1999) concerned 10,665 patients (50,383 in corrected numbers) and 8,377 physicians and the second study (15 days in January 2003) concerned 2,584 patients and 2,376 physicians. The average age of the patients was 63.1 ± 0.2 years in 1999 and 64.4 ± 0.4 years in 2003. In 1999, 23.7 ± 0.9% of the patients entirely complied with the life-style recommendations in the guidelines compared to 25.3 ± 1.7% in 2003. Patient prescriptions contained a potentially contra-indicated medication in 27.3 ± 1.3% of the patients in 1999 and in 32.9 ± 2.6% in 2003. Between 1999 and 2003, the proportion of well-controlled patients (SBP and DBP < 140/90 mm HG or SBP = or < 160 mm Hg if more than 60 years-old with isolated systolic HBP) increased from 40.8 ± 1.1% to 45.5 ± 1.9%. Using the thre-shold of 130/85 mm Hg, 6.7 ± 1.1% of the diabetic patients were considered well-controlled in 1999 and 5.4 ± 1.7% in 2003. Using the threshold of 125/75 mm Hg, 5.2% of patients in kidney failure were considered well-controlled in 1999 and 2.8% in 2003. Conclusions: Between 1999 and 2003, the results on blood pressure control were generally improved but remained insufficient with respect to diabetics and patients in kidney failure. These somewhat mixed results are nevertheless encouraging for those who have tried to ameliorate medical practice by addressing appropriate messages to the general public, patients or healthcare professionals.