Treating high blood pressure can save you a lot of trouble by reducing your risk of heart attack, stroke, kidney failure, and even Alzheimer’s disease. And yet, in France, nothing is going well. The latest data from the Esteban study published in 2018 revealed that since 2006 screening has not made any progress and even that the proportion of women receiving treatment has declined.
With hypertension, the arteries of the body become rigid, clogged up and eventually seriously damage the heart, brain, kidneys. On average 30% of French people are hypertensive. From the age of 60, this figure rises to 60%. The problem is therefore colossal. Arterial hypertension is generally silent, causing no symptoms before complications, with some exceptions. In France, one in two hypertensive people is aware of their hypertension; among them, one in two is treated. And finally, only one in two people treated would have normal blood pressure.
Lifelong treatment
“Half of the patients are not screened, deplores Professor Michel Azizi, head of the arterial hypertension service at the Pompidou hospital in Paris. Screening in companies has decreased, there is no longer any military service to examine young men, university medicine has few resources. Today I see in consultation people suffering from very advanced hypertension who have completely fallen through the cracks of screening. Control of high blood pressure has deteriorated. And yet, we have all the means to act ”.
Hypertension is when the blood pressure is above 140/90 millimeters of mercury. Be careful, a single measure is not enough to declare that a person is concerned. “The French Society of Arterial Hypertension considers that there is no question of prescribing a treatment, before a self-measurement of the blood pressure at home or a blood pressure holter which automatically takes the blood pressure at regular intervals for 24 hours”, affirms the doctor Nicolas Postel-Vinay, who provides consultations at the Pompidou hospital. From the moment a treatment is prescribed, it is a priori for life. It should not be a decision taken lightly.
“Poor hypertension control is not related to a lack of medication, but to a problem of adherence. When we check the presence of prescribed drugs in the urine to understand why the treatment is not effective, we really have surprises ”, continues Dr Nicolas Postel-Vinay. Half of patients are not taking their treatment correctly, according to a study conducted at Pompidou Hospital. “Mistrust vis-à-vis drugs, the fear of being ill while taking them, the idea of regaining power over oneself are all reasons for this deleterious non-compliance,” analyzes Professor Michel Azizi. This non-observance exposes the complications of hypertension, leads to unnecessary check-ups, increases health costs. “
New strategies are emerging
When hypertension has been confirmed, with a precise assessment to assess its impact, treatment can begin. In addition to lifestyle measures, drugs are most often necessary, sometimes in combination. The pharmacopoeia is not lacking. The choice depends on age, associated diseases, contraindications, knowing that these molecules are well tolerated, whether they are converting enzyme inhibitors, sartans, calcium channel blockers, diuretics, alpha blockers, beta blockers, central antihypertensive drugs … “To improve compliance, tablets have been developed which include two different molecules”, adds Dr. Postel-Vinay. There are also combinations of three drugs in one tablet that are very useful in making life easier for patients on a daily basis. They are not reimbursed in France, unlike elsewhere in Europe and in the world.
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New sophisticated strategies are being evaluated for drug-resistant patients such as renal denervation by ultrasound, tested at the Pompidou hospital, electrical stimulation of carotid artery baroreceptors, or messenger RNA “vaccines” with an injection every once in a while. six months… In reality, the fight against sedentary lifestyle, improving screening and compliance are the main keys today to meet the challenge of hypertension in France.
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