What would be the impact on the burden of hypertension of achieving public health goals?

Abstract Background High blood pressure is responsible for 55,000 deaths and 390,000 hospitalizations per year in France. Although excessive salt consumption, physical inactivity, and obesity are well-known major risk factors for hypertension, they remain highly prevalent in the general French population. Purpose The aim is to study the impact of achieving World Health Organization (WHO) or national prevention goals, in France, through primary prevention measures or improvement in the management rate of uncontrolled hypertension cases on hypertension-related morbidity and mortality. Methods The potential impact fraction (PIF) and the number of avoidable deaths and hospitalizations were estimated using blood pressure data from the Esteban survey, 2021 morbidity and mortality data from a national medicoadministrative database, and hypertension-related complication risks from the literature. The impact of systolic blood pressure (SBP) reductions and associated complications (cardio-cerebro-vascular and renal diseases) was assessed under four scenarios and was quantified at the national level: Scenario 1: Reduce the population's daily salt intake by 40%. Scenario 2: Increase physical activity so that 80% of adults reach the recommended level (75–150 min/week). Scenario 3: Reduce the prevalence of adult obesity by 15% Scenario 4: Reduce the uncontrolled hypertension rate by 25% Results Scenario 1, which would result in an average daily salt intake of 5g/day (compared to 8g currently) and an average reduction in SBP of 4,9 mmHg, could prevent 8% of cardio-cerebro-vascular and renal diseases, thereby avoiding 19,494 deaths and 140,996 hospitalizations attributable to hypertension. The 29% increase in physical activity modelled in Scenario 2 could prevent 2.0% of cardio-cerebro-vascular and renal diseases, equivalent to 3,696 deaths and 21,534 hospitalizations attributable to hypertension. Scenario 3 could prevent 0.7% of cardio-cerebro-vascular and renal diseases, corresponding to 1,276 deaths and 8,188 hospitalizations attributable to hypertension. Finally, a 25% reduction in the uncontrolled hypertension in France would prevent 7.0% of hypertension complications (11,808 deaths and 77,600 hospitalizations). Conclusion(s) The burden of hypertension could be significantly reduced by achieving national public health goals. Given the expected benefits ambitious prevention measures, targeting both primary prevention and the management of hypertension, should be implemented to reach these objectives.