What are the real prevalence of hypertension in France

Background/introduction Multipke lood pressure (BP) measurements during several visits are recommended for diagnosis of hypertension. However, in epidemiological studies, BP is frequently measured during a single visit. It has been widely described that the prevalence of hypertension based on BP measurement at a single visit is overestimated because of the regression to the mean phenomenon. Purpose The aim of our study was to give an unbiased estimate of the hypertension prevalence in France. Methods Esteban was a cross-sectional survey implemented in 2015 based on a random sample of the French population. Three standardized BP measurments were performed during a clinical exam. Hypertension was defined as BP ≥ 140/90 mmHg or hypertensive treatment. After correcting BP to account for the within-person variability (estimated from other studies with repeated visits), we estimated the prevalence of hypertension and the proportions of treated and controlled hypertensives and the number of hypertensives in France. Results The prevalence estimates of hypertension from the Esteban study decreased from 30.6% using observed data to 22.6% after correction with the BP variability. The proportion of drug-treated hypertensive patients increased from 48.9 to 67.8% and the proportion of controlled BP among treated patients from 49.6% to 52.1%, before and after correction respectively. By applying these corrected proportions to the French adult population by sex and age categories, the number of hypertensive patients reached 13,000,000, of which 9,000,000 were treated. Conclusion Using estimation of the within-person variability from other studies, the new prevalence of hypertension in the French adult population would be around 22.6% (13 million people) after correction. Taking into account BP variability could avoid a substantial over-estimation of the prevalence of hypertension at the population level.