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

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/m(2)). 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.