Hypertension remains poorly controlled in France despite available treatments. Therapeutic inertia and non-adherence of physicians to guidelines contribute to this situation.

This study aimed to evaluate general practitioners’ (GPs) practices in the initial management of hypertension in Seine-Saint-Denis, a socioeconomically disadvantaged French department.

We conducted a cross-sectional study using an online self-administered questionnaire from March to May 2025. Fifty-three GPs completed the survey regarding their diagnostic, therapeutic, and follow-up practices in the management of hypertensive patients.

Most physicians (66%) used the recommended 140/90 mmHg office threshold for hypertension diagnosis, and 94% confirmed diagnosis with ambulatory measurements. However, only 55% used cardiovascular risk scores to assess prognosis, and key recommended diagnostic investigations (electrocardiogram: 43%; urinary albumin: 47%) were underperformed. Initial antihypertensive therapy was predominantly monotherapy (83%) whereas dual therapy was prescribed in 17% of patients, and blood pressure targets were frequently set higher than recommended. Notable variations in practice were observed according to physician age, gender, and years of experience.

Although GPs in Seine-Saint-Denis generally adhere to basic hypertension management principles, significant gaps remain in cardiovascular risk assessment, initial workup completeness, and timely treatment intensification. Targeted interventions are needed to enhance guideline implementation in this vulnerable territory.