Transthyretin amyloid polyneuropathy in France: A cross-sectional study with 413 patients and real-world tafamidis meglumine use (2009-2019).

OBJECTIVE: We aimed to describe characteristics of patients with ATTR variant polyneuropathy (ATTRv-PN) and ATTRv-mixed and assess the real-world use and safety profile of tafamidis meglumine 20mg. METHODS: Thirty-eight French hospitals were invited. Patient files were reviewed to identify clinical manifestations, diagnostic methods, and treatment compliance. RESULTS: Four hundred and thirteen patients (296 ATTRv-PN, 117 ATTRv-mixed) were analyzed. Patients were predominantly male (68.0%) with a mean age of 57.2±17.2 years. Interval between first symptom(s) and diagnosis was 3.4±4.3 years. First symptoms included sensory complaints (85.9%), dysautonomia (38.5%), motor deficits (26.4%), carpal tunnel syndrome (31.5%), shortness of breath (13.3%), and unexplained weight loss (16.0%). Mini-invasive accessory salivary gland or punch skin and nerve biopsies were most common, with a performance of 78.8-100%. TTR genetic sequencing, performed in all patients, revealed 31 TTR variants. Tafamidis meglumine was initiated in 156/214 (72.9%) ATTRv-PN patients at an early disease stage. Median treatment duration was 6.00 years in ATTRv-PN and 3.42 years in ATTRv-mixed patients. Tafamidis was well tolerated, with 20 adverse events likely related to study drug among the 336 patients. CONCLUSION: In France, ATTRv patients are usually identified early thanks to the national network and the help of diagnosis combining genetic testing and mini-invasive biopsies.

Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018.

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.

[Differences between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM)]. / Différences de prise en charge de l'HTA entre la métropole et les DOM-ROM.

BACKGROUND: High blood pressure (HBP) is the most common chronic disease worldwide. In France, its prevalence varies by region. It is high in most Overseas Departments and Regions (DOM-ROM), at 38.2% in Réunion (1), 44% in Mayotte (2), 28% in the French Antilles, 18% in French Guiana, 25% in French Polynesia (3) and 28% in Saint-Martin (4). PURPOSE: To determinate the differences within the same healthcare system between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM). RESULTS: Sex-based differences. In contrast to Metropolitan France, in Overseas France the prevalence of HBP is higher in women, although women show better rates of care (screening and rates of patients "normalised" under medical treatment). The main explanation for this is the higher prevalence of obesity in women. Obesity multiplies the risk of developing hypertension by 2.5 Obesity in Guadeloupe affects 14% of men compared to 31% of women. Socio-economic particularities of hypertension in Overseas France. The numerous epidemiological surveys carried out in the French Antilles have demonstrated the major role of socio-economic conditions in the occurrence of hypertension, alongside the usual risk factors such as sedentary lifestyle, salt consumption and obesity (7). In the absence of socio-economic disparity, there is no significant disparity in the prevalence of hypertension specially in men. CONCLUSIONS: There are differences between France Overseas Regions and Territories (DOM-ROMs) and Metropolitan France in terms of the prevalence, knowledge, treatment and control of hypertension, and these vary according to sex. For men, the prevalence and treatment of hypertension differ very little when considering a population of workers or employees in both regions. On the other hand, for women, the prevalence of hypertension is higher in the French Antilles-Guiana. This difference is not fully explained by the higher prevalence of obesity observed among female employees in the French Antilles-Guiana. For these patients, we also observe better knowledge and better control of hypertension. Care for men in socio-economically disadvantaged situations of precarity must be improved in terms of screening and adherence to treatment.

Elevated alveolar nitric oxide is linked to poor aerobic capacity and chronotropic incompetence in liver transplant candidates.

BACKGROUND & AIMS: Increased nitric oxide is involved in abnormal hemodynamic parameters and respiratory function of cirrhotic patients. We aimed to quantify partitioning exhaled nitric oxide measurements in exhaled air in liver transplantation (LT) candidates and evaluate their relationships with chronotropic incompetence and aerobic capacity. METHODS: We compared exhaled nitric oxide (NO) measurements, heart rate response and peak oxygen uptake during incremental exercise in liver transplantation candidates to those of controls. RESULTS: As opposed to healthy control subjects, LT candidates displayed elevated alveolar NO, blunted chronotropic response and reduced V'O2 at maximal exercise. In LT candidates, median peak V'O2 was 18.7 ml kg-1 min-1 (interquartile range (IQR) 16.2; 21.8), corresponding to 65% (IQR 57; 72) of the predicted value. Compared with controls, LT candidates had increased levels of alveolar NO (median (IQR) 2.0 (1.2; 2.2) versus 3.1 (2.3; 4.5), p < 0.001). In controls, no relations were found between alveolar NO and V'O2 peak or heart rate reserve whereas in cirrhotic patients, negative correlations and negative slopes were found between alveolar NO and V'O2 peak and heart rate reserve decrease. CONCLUSIONS: Increasing alveolar NO could be a specific pathophysiological condition limiting aerobic capacity in LT candidates.

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.

[Precariousness, cardiovascular risk in the afro-Caribbean population of Saint-Martin. Data from the study CONSANT-SM]. / Précarité, risque cardiovasculaire dans une population afrocaribéenne de Saint-Martin. Données de l'étude CONSANT-SM.

OBJECTIVE: The objective is to describe the prevalence of arterial hypertension (hypertension) and cardiovascular risk factors (FDR) and specify their association with the socio-economic factors in a collectivity of Saint-Martin. MATERIAL AND METHODS: CONSANT-SM is a cross-sectional descriptive study carried out on a representative sample of 400 people. The data collection was conducted by investigators at home. RESULTS: The low income level is significantly associated with abdominal obesity (OR=2.3), with cardiovascular FDR accumulated (OR=3.58). Low level of education (OR=2.86) and abdominal obesity (OR=3.73) are significantly associated with hypertension. DISCUSSION: The link between cardiovascular FDR and precariousness (in our study represented by the variable low levels of income and education) is found in this study carried out on a representative sample of the population of the community of Saint-Martin. CONCLUSION: The strong link between hypertension, obesity and others cardiovascular risk factors (FDR) with precariousness (in our study represented by the variable low levels of income and education) is found in this afro-Caribbean population. This data is an important information for the health program developed by the healthy system.

[High blood pressure and obesity: disparities among four French overseas territories]. / Hypertension artérielle et obésité : disparités entre quatre régions d'Outre-mer.

BACKGROUND AND PURPOSE: The epidemiological characteristics of hypertension and obesity in French overseas territories (FOTs) have never been compared. METHODS: This cross-sectional survey included representative population-based samples of 602, 601, 620 and 605 men and women aged more than 15 years, respectively, from four FOTs of Guadeloupe, Martinique, French Guiana, and French Polynesia. Hypertension was defined as blood pressure (BP) at least 140/90mmHg or the current use of antihypertensive treatment. RESULTS: The prevalence of hypertension was 29.2% in Guadeloupe, 17.9% in French Guiana, 27.6% in Martinique and 24.5% in French Polynesia. Considering the Guadeloupe population as the reference group, prevalence of hypertension was significantly lower in French Guiana (P<0.001), even after controlling for age and sex (PU0.006). Awareness and treatment of hypertension were similar in French Guiana, Martinique and Guadeloupe (68.8-75.1% and 69.0-73.4%, respectively). Awareness was lower in French Polynesia (50.0%, adjusted P value U0.04), as was treatment of hypertension (32.4%, adjusted P value U0.001). Control of hypertension was also lower in French Polynesia (8.8%, adjusted P value U0.001) compared with the other territories (29.7-31.8%). French Polynesia had the highest prevalence of obesity (33.1%, adjusted P value<0.001) as compared with the other territories (17.9-22.8%). It had also the largest population attributable fraction of hypertension due to obesity (35.5%) compared with Guadeloupe (13.3%), Martinique (12.3%) and French Guiana (23.6%). CONCLUSION: Wide variations were observed in the prevalence and the management of hypertension between these FOTs, and an especially challenging low control of hypertension was found in French Polynesia. Obesity appears a key target to prevent hypertension, particularly in French Polynesia.

'Green Apple' Heart Failure.

We report here the clinical case of an Afro-Caribbean patient referred for complete atrioventricular block for whom a diagnosis of hereditary cardiac amyloidosis was eventually confirmed. Hereditary cardiac amyloidosis is an emerging threat in the Caribbean, and the main goal of this report is to raise the awareness of the disease among physicians.

[Television viewing and cardiovascular risk behaviors in the adult population of the French West Indies]. / Comportements à risque cardiovasculaire et médias télévisuels en population adulte guadeloupéenne.

OBJECTIVE: Recent studies have shown a link between prolonged television viewing and cardiovascular (CV) morbidity and mortality. We aimed to estimate the relationship between television viewing and CV risk behaviors and in the adult population of the French West Indies. PATIENTS AND METHODS: We used data from Consant, a cross-sectional study carried out in 2007 on a representative sample of the adult Guadeloupean population (1005 subjects aged 25-74 years selected by stratified random sampling and interviewed at home by trained investigators working in pairs). RESULTS: Among respondents who reported watching television for 2 hours or more per day, 46.5% stated practicing no leisure time physical activity, compared with 35.6% among those who reported watching television for less than 2 hours per day. Adjusting for age, sex, education, income, family status, and perceived CV benefits of physical activity, the odds ratio of physical inactivity was estimated at 1.75 (P<10(-3)) among subjects who reported watching television for 2 hours or more per day, compared with other subjects. A similar relationship was observed when considering dieting to prevent weight gain. CONCLUSION: In this representative sample of a French Caribbean population, a strong and very significant relationship was observed between prolonged television viewing and CV risk behaviors. Prolonged television viewing seems common to a lifestyle that is characterized by little physical activity and unhealthy eating habits. This may play a role in social inequalities observed in CV diseases.

[Hypertension and perceived material insecurity in a disadvantaged Caribbean population]. / HTA et précarité perçue en population précaire guadeloupéenne : l'enquête PHAPPG.

OBJECTIVE: To assess the relationship between hypertension and perceived material insecurity in a disadvantaged Caribbean population. PATIENTS AND METHODS: We used data from a cross-sectional study involving 2420 disadvantaged subjects aged 18-69 years, included consecutively at three Guadeloupian health centers. Hypertension was diagnosed over two consultations with a total of six blood pressure measurements. Perceived material insecurity was assessed using a closed-ended question. RESULTS: The prevalence of hypertension was estimated at 17.7% among subjects who believed their material situation would improve in the future, at 28.2% among those who believed it would remain the same, and at 43.3% among those who believed it would deteriorate. A multivariate logistic regression analysis showed that hypertension risk more than doubled (OR: 2.35 - P: 0.002) among subjects who believed that their material situation would deteriorate in the future compared to those who believed that their situation would improve, with no significant sex-related differences. This relationship was especially strong among subjects aged 40 years or more (OR: 3.30 - P<10(-3)), and among subjects with low education level (OR: 3.81 - P: 0.003), but was independent of the other tested variables. CONCLUSION: In this disadvantaged population, perceived material insecurity is a psychosocial factor strongly associated with hypertension, independently of subjects' risk behaviors. Subjects aged 40 years or more and subjects with a low education level seem the most vulnerable.

The prevalence of overweight and obesity, and distribution of waist circumference, in adults and children in the French Overseas Territories: the PODIUM survey.

AIM: This study aimed to describe the prevalence of overweight (excluding obesity) and obesity, and distribution of waist circumference, in children and adults in four French Overseas Territories (Guadeloupe, Martinique, French Guiana in the Caribbean and French Polynesia in the Pacific Ocean). METHODS: The survey was designed to provide a sample representative of the population in each of the four territories. The protocol aimed to evaluate 600 adults (aged ≥ 15 years) and 300 children (aged: 5-14 years) in each territory. RESULTS: In children, the differences were small among the territories in the prevalence of overweight (excluding obesity), as defined by the International Obesity Task Force (IOTF): Guadeloupe, 15.4%; Martinique, 17.0%; French Guiana, 13.2%; and French Polynesia, 17.2% (P = 0.49). Larger, significant, differences were observed for obesity, with prevalences of 7.2%, 7.7%, 5.4% and 15.9%, respectively (P < 0.002). In adults, the prevalence of obesity also differed significantly among the territories: 22.9%, 22.0%, 17.9% and 33.1% in Guadeloupe, Martinique, French Guiana and French Polynesia, respectively (P < 0.001, adjusted for age and gender). However, overweight (excluding obesity) was again more homogeneously distributed, with prevalences of 31.7%, 33.6%, 30.3% and 34.4%, respectively (P = 0.43, adjusted for age and gender). Waist circumference was larger in French Polynesia than in the other territories in both genders, and in both children and adults. CONCLUSION: While the distribution of overweight was relatively homogeneous, the prevalence of obesity differed considerably across the four territories. It was especially high in French Polynesia, and in children and women. Appropriate programmes are urgently needed in these populations, especially in children, to avoid the morbidity associated with obesity.

[Knowledge of hypertension among hypertensive patients in general practice, and its relation to achieving therapeutic goals: The Co-HACT study, French West Indies]. / Niveau de connaissance de leur pathologie des patients hypertendus suivis en médecine générale et sa relation avec l'obtention des objectifs thérapeutiques. Étude Co-HACT, DOM-TOM.

OBJECTIVES: Appraisal of the agreement between patients' reports and general practitionners' declaration in a French Caribbean population and relationship with blood pressure normalization. METHODS: One hundred French Caribbean practitioners participated in this observational survey: each of them included five essential hypertensives treated for more than three months. BP was considered to be normalized if inferior to 140/90 mmHg. We considered that there is a total agreement between patient and GP declaration when SBP and DBP did not differ by more than 5 mmHg and when the eight risk factors or co-morbidity were identical. Identification of independent factors of BP normalization and awareness was performed using logistic regression. RESULTS: Five hundred and nine hypertensives (57% women) were recruited. Sixty-nine percent (n = 328) were less than 65 years, 75% (n = 341) had an educational level less than high school. The normalisation rate was 39% (n = 185) within the whole population. 63.4% had a high cardiovascular risk. BP normalization appeared to be closely associated to BP awareness. CONCLUSIONS: In this observational survey, in a French Caribbean hypertensive population, two third had a high cardiovascular risk. The normalization rate was 39%. This BP normalization appeared to be closely associated to BP awareness.

[Arterial-hypertension prevalence in the general population of Martinique]. / Prévalence de l'hypertension artérielle en population générale à la Martinique.

BACKGROUND: Since 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level. METHODS: Cross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140mmHg and/or diastolic pressure greater than 90mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index. RESULTS: Study concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p=0.88. The prevalence rate of hypertension is 29% [IC(95%): 25.9-31.8] in the sample and declines to 22.5% [IC(95%): 20.1-25.1] using weighted data. The prevalence rate is 33.1% [IC(95%): 30.2-36.6] for overweight and 20.1% [IC(95%): 17.8-22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p<0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p<0.05). CONCLUSION: The high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.

[The prevalence of abnormal glucose regulation after myocardial infarction: Comparative study in two French ethnic groups]. / Anomalies du métabolisme glucidique au décours d'un syndrome coronarien aigu : une étude comparative de deux groupes ethniques français.

OBJECTIVES: The aim of this study was to compare the prevalence of abnormal glucose tolerance in patients stemming from two French ethnic groups and admitted for acute coronary syndrome (ACS) to intensive coronary care unit. MATERIALS AND METHODS: During a period of six months, 53 and 60 consecutive patients were enrolled at Fort-de-France (Martinique, French West Indies, Afrocaribbeans, group F) and at Bordeaux (France, Europeans, group B), respectively. Glucometabolic state was classified according to medical history and fasting glycemia measured from the fourth day after ACS. RESULTS: At baseline, 36% of the patients of group F and 20% of the patients of group B had previously known diabetes (p=0.06). Prevalence of hypertension was higher in Afrocaribbeans than in Europeans (60 versus 40%, p<0.05). According to fasting glycemia, newly detected diabetes were found in six Afrocaribbeans and only one was found in Europeans; two patients in group F and three patients in group B displayed impaired fasting glycemia. As a whole, 51% of Afrocaribbeans and 27% of Europeans showed abnormal glucose tolerance (p<0.05). Furthermore, Afrocaribbeans displayed lower levels of triglycerides and higher levels of HDL cholesterol than Europeans (p<0.05). CONCLUSION: Our study suggested a higher prevalence of impaired glucose metabolism in French Afrocaribbeans than in European counterparts after ACS. Furthermore, French Afrocaribbeans displayed a more favorable lipoprotein profile. These characteristics look like that of the American and British Afrocaribbeans, maybe because of a common genetic origin.

[Obesity and high blood pressure in French West Indies women, some difference according to definition of obesity; BMI or abdominal obesity]. / Obésité et hypertension artérielle chez la femme antillaise, la prévalence diffère selon la définition utilisée, indice de masse corporelle ou tour de taille.

OBJECTIVES: To compare prevalence of abdominal obesity with obesity defined as BMI >or=30 kg/m2 in a West Indies population, and to define the relation between obesity and hypertension. METHODS: A cross-sectional study of 2420 consecutive unemployed subjects referred for check-up in the two health centres of Guadeloupe, a French Caribbean island. Height and weight were measured and the body mass index (BMI) was calculated as weight/height2 (kg/m2). Obesity was defined as BMI >or=30 kg/m2 and excess weight as BMI >or=25 kg/m2 and<30 kg/m2. Abdominal obesity was defined as waist measurement more than 88 cm for women and more than 102 cm for men. RESULTS: [table: see text] CONCLUSION: A high prevalence of obesity was observed in this Caribbean population suggesting the interest of primary prevention in The Caribbean. In women, abdominal obesity (waist measurement>88 cm) was more frequent than obesity defined as BMI>30 kg/m2). In a multivariate analysis, obesity is an independent risk factor of hypertension (Odds-ratio=3), however the definition of obesity.

[Treatment of hypertension in Guadeloupe (FWI) in 2005: Pretrahguad study]. / Traitements médicamenteux et non médicamenteux chez l'hypertendu en Guadeloupe en 2005 : enquête PRETRAHGUAD.

OBJECTIVES: To estimate life style and drug therapy for treatment of hypertension in Guadeloupe (FWI) in 2005, and to compare the data with those obtained in a similar study realised in France metropolitan population in 2004. METHODS: A cross-sectional study of a sample of 509 subjects selected as being representative of the Guadeloupe population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was administered by phone. RESULTS: In 2005, 32% of the population above the age of 35 years was treated for hypertension, corresponding to an estimate of 51,230 subjects. Hypertensive subjects experienced: a weight loss of more than 3 kg in 29 vs 25% in the general population, an increased in fruits and vegetables consumption in 29 vs 46%, a decreased in cheese (11 vs 8%), pork-butchery (23 vs 16%) and alcohol consumption (10 vs 6%). The percentage of subjects who increased their physical activities was not different in the two groups (24 vs 25%). We observed a larger use of diuretics and ACE-I/ARBs prescribed as combined drugs. The most frequent drug prescribed as single drug is calcium antagonist. When the patients are receiving at least two medications or more (41%), combined treatment is found with high frequency (75%). CONCLUSION: Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices. When comparing with FLAHS study concerning the French metropolitan population, diuretics and calcium antagonist are more often prescribed in Guadeloupe, in witch 90% of the population is Afro-Caribbean.

[Prevalence of hypertension in a disadvantaged population in Antilles: a major role for obesity?]. / Prévalence de l'HTA en population précaire aux Antilles : rôle majeur de l'obésité?

UNLABELLED: The aim of this study was to evaluate the prevalence of hypertension and its management in a disadvantaged population, essentially composed of those receiving state subsidies and the unemployed. METHODS: The PHAPPG study : Prevalence of Hypertension in a Population Précaire Guadeloupéenne (disadvantaged population in Guadeloupe) included 2420 consecutive people considered to be 'disadvantaged' seen in the two medical examination centres in Guadeloupe between November 2001 and November 2003. RESULTS: The prevalence of obesity was considerable throughout the female population of Antilles (29%). It was recorded in 12% of men. The prevalence of hypertension in the population was 24.7% for men and 22.1% for women. Obesity was the main factor that could explain the higher prevalence of hypertension noted in Antilles, especially among 'disadvantaged' women. In effect, after correction for other risk factors and for age, this prevalence of hypertension was on average three times higher amongst the obese compared to subjects with normal weights. CONCLUSION: The prevalence of hypertension is elevated in the population of Antilles, especially among the disadvantaged. Obesity is the key factor, upon which a primary prevention policy for hypertension could be based.