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Treatment and adherence to antihypertensive therapy in France: the roles of socioeconomic factors and primary care medicine in the ESTEBAN survey

Abstract

Antihypertensive drugs remain one of the main beneficial strategies for cardiovascular disease prevention. The objective of our study was to investigate the associations of different clinical and socioeconomic (SES) factors, and the use of primary care medicine with treatment and adherence (proportion of days covered (PDC) by treatment) to hypertension management in French participants aware of their hypertension. Cross-sectional analyses of treatment for hypertension and adherence to treatment were performed using data from 396 participants from the ESTEBAN survey, a representative sample of the French population. Logistic regression analyses were performed to investigate associations between SES factors (age, sex, education, income, civil status), clinical factors, health care (general practitioner (GP) visits, cardiologist visits, number of consultations, home blood pressure measurement (HBPM)), treatment and adherence. A total of 265 of the 396 hypertensive patients were treated. Antihypertensive drug use was more common among elderly individuals (OR: 2.73 [1.14; 4.32), diabetic patients (OR: 4.18 [1.92; 6.44] and overweight hypertensive patients (OR = 3.04 [1.09; 4.99]). GP consultations and HBPM were associated with increased treatment (OR: 1.03 [1.01; 1.05]; OR: 1.97 [1.06; 2.61], respectively). The PDC was higher among men (p = 0.045) and couples living together (p = 0.018) but lower among diabetic patients (p = 0.012) and patients visiting a cardiologist (p = 0.008). Education and income levels were not associated with either treatment or the PDC. In France, SES factors seemed to have little impact on treatment and adherence to antihypertensive drug regimens. However, treatment administered by GPs and HBPM may play key roles in hypertension management. Although the PDC was quite low, both the number of GP consultations and HBPM were positively associated with pharmacological treatment.

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Acknowledgements

The authors thank the Centers for Health Examinations, the Cetaf and the laboratories involved in the data collection, as well as the entire ESTEBAN team and study participants. The ESTEBAN study, part of the National Biosafety initiative, is financed by the Ministry of Solidarities and Health and the Ministry of Ecological and Solidarity Transition. The authors thank Jeffrey Arsham for editorial assistance.

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Correspondence to Jacques Blacher.

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Conflict of interest

AV, CG, AG and VO have no conflicts of interest. Outside of this work, JB has received research support or has served on advisory boards or as a speaker for Abbott, Amgen, Astellas, Astra-Zeneca, Bayer, Boehringer, Ingelheim, Bouchara-Recordati, Daiichi Sankyo, Ferring, Gilead, Icomed, Medexact, Medtronic, Novartis, Novo Nordisk, Quantum Genomics, Saint Jude, Sanofi Aventis, and Servier.

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All procedures performed in studies involving human participants were in accordance with the ethics standards of the institutional and/or national research committee and with the principles of the 1964 Helsinki declaration and its later amendments or comparable ethics standards.

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Informed consent was obtained from all individual participants included in the study.

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The study was registered with the French National Agency for Medicines and Health Products Safety (No. 2012-A00456-34) and was approved by the Advisory Committee for Protection of Persons in Biomedical Research.

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Vallée, A., Grave, C., Gabet, A. et al. Treatment and adherence to antihypertensive therapy in France: the roles of socioeconomic factors and primary care medicine in the ESTEBAN survey. Hypertens Res 44, 550–560 (2021). https://doi.org/10.1038/s41440-020-00603-z

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Keywords

  • Hypertension
  • Adherence
  • Drug treatment
  • Socioeconomic status
  • Primary care medicine

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