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Determinants of blood pressure treatment and control in obese people: evidence from the general population

Czernichow, Sébastiena,b; Castetbon, Katiac,d; Salanave, Benoitc,d; Vernay, Michelc,d; Barry, Yayac,d,e; Batty, George D.f; Hercberg, Sergec,d,e; Blacher, Jacquese,g

doi: 10.1097/HJH.0b013e3283593010

Objective: We assessed hypertension prevalence, blood pressure (BP)-lowering treatment and control in obese adults compared with lean/normal-weight individuals in France.

Methods: Multistage stratified random sample of 2075 adults from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006–2007. BP was measured three times on the left arm using an automatic device. Weight and height were assessed using standardized methods to compute body mass index (BMI, kg/m2). BP-lowering drugs were self-reported. BP control was defined as SBP/DBP less than 140/90 among hypertensive individuals.

Results: As anticipated, mean SBP and DBP increased significantly across BMI categories (P for trend <0.0001). The age-adjusted and sex-adjusted prevalence of hypertension also increased across the same categories (15.7, 24.7 and 56.9%, respectively, P < 0.001). Among hypertensive individuals, obese participants were more likely to receive BP-lowering drugs compared with their lean/normal weight counterparts (P = 0.02). However, independently of age, smoking status and alcohol intake, obesity was associated with a 62% lower risk of BP control (OR: 0.38, 95% CI: 0.19–0.75) compared with the lean/normal-weight status.

Conclusion: Although hypertension was much more prevalent in the obese compared with overweight and lean/normal-weight individuals, uncontrolled hypertension was also more frequent despite a higher rate of treatment. To some extent, this observation may probably be the consequence of obesity and its complex pathophysiology, more than to an inadequate therapeutic decision by clinicians.

aDepartment of Nutrition, Assistance Publique-Hôpitaux de Paris, Hôpital A. Paré (AP-HP), Université Versailles St-Quentin, Boulogne

bINSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif

cInstitut de veille sanitaire, Unité de surveillance et d’épidémiologie nutritionnelle (USEN), Saint Maurice

dUniversité Paris 13, Sorbonne Paris Cité, Unité de surveillance et d’épidémiologie nutritionnelle (USEN), Bobigny

eUMR U557 Inserm; U1125 Inra; Cnam; UP13, Sorbonne Paris Cité, CRNH Idf, Bobigny, France

fUniversity College London, Research Department of Epidemiology and Public health, London, UK

gUniversité Paris-Descartes, Faculté de Médecine; AP-HP; Hôtel-Dieu, Centre de Diagnostic et Thérapeutique, Paris, France

Correspondence to Professor Sébastien Czernichow, Unité de Nutrition, Hôpital Ambroise Paré, 9, Avenue Charles-de-Gaule, 92210 Boulogne-Billancourt, Paris, France. Tel: +33 (0)1 49 09 47 66; fax: +33 (0)1 49 09 58 80; e-mail:

Abbreviation BP, blood pressure

Received 20 February, 2012

Revised 28 June, 2012

Accepted 10 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.