Changes in prevalence, awareness, treatment and control of hypertension in disadvantaged French Caribbean populations, 2003 to 2014
In 2003, the PHDG (Prevalence of Hypertension among Disadvantaged Guadeloupeans) study highlighted poor management of hypertension in an unemployed French Caribbean population. New processes of health-care coordination and a pay-for-performance system have since been developed. We aimed to assess changes in hypertension characteristics in disadvantaged French Caribbean populations in the last 10 years. Using PHDG 2003 data, in 2014 we undertook a cross-sectional study with identical methods. The source population comprised all Guadeloupeans having undergone periodic heath checks offered by the Social Security insurance at these dates. Only universal health coverage beneficiaries (i.e. in situations of poverty) aged 18-64 were included (2014 in 2014, 1868 in 2003). Hypertension was defined by antihypertensive treatment or a mean of two blood pressure measures ≥ 140/90 mm Hg. The 2003 and 2014 data were age adjusted; comparative morbidity factors (CMF) and 95% confidence intervals were calculated to assess changes over time. Hypertension prevalence decreased from 38.3 to 34.5% (CMF 95% CI: 0.83-0.97). The increase in hypertension awareness was greater for women (from 48.3 to 55.3%, CMF 95% CI: 1.00-1.31) than for men (from 28 to 31.1%, NS). Among hypertensive individuals aware of their condition, proportions of those treated increased for women (from 83.1 to 88.3%, NS) but decreased for men (from 80.2 to 75.8%, NS). Controlled hypertension among treated patients increased in women (from 35.2 to 49.2%, CMF 95% CI: 1.07-1.82) and men (from 12.9 to 30.1%, CMF 95% CI: 1.30-4.21). In conclusion, in these poor French Caribbean populations with theoretically adequate access to care, hypertension control remained far below national goals. Neither awareness nor treatment had improved in men.