Aim: to measure the change in blood pressure control in two populations of pa tients with severe high blood pressure between 1999 and 2003. Method: the French National Health care Fund performed two observational, cross sectional surveys on the medical management of high blood pressure, the first in 1999 and the sec ond in 2003. Each survey enrolled patients aged between 20 and 80 years old who filed a first time request for exemption from co payments for this long term disorder. Study data was collected by the health funds salaried physician advi sors who directly examined the patients and from information gathered from each patients attending physician. Adequate blood pressure control was defined acco rding to the guidelines set out by the ANAES in 1997 and determined by calculati ng the average of the last three blood pressure figures recorded by the patient s attending physician (systolic [SBP] and diastolic [DBP] arterial blood p ress ures). Results: 10,665 patients were enrolled in the 1999 survey and 2,584 were enrolled in the 2003 survey. The average age was 63.1±0.2 years in 1999 and 64. 4±0.4 years in 2003. The proportion of diabetic patients in the two surveys rem ained stable: 27.5%±1.0 in 1999 and 28.4%±1.7 in 2003. Between 1999 and 2003 , the percentage of patient who were treated for hypercholesterolemia increased from 44.0%±1.1 to 54.3%±1.9. Between 1999 and 2003, the proportion of patien ts who were considered well controlled (SBP and DBP<140/90 mmHg) or, if older t han 60 years with isolated systolic high blood pressure (DBP< 90 mmHg and SBP≤1 60 mmHg) increased almost 5%points, going from 40.8%±1.1 in 1999 to 45.5%±1 .9 in 2003. In diabetic patients, in whom the cut off threshold is 130/85 mmHg, 6.7%±1.1 were considered well controlled in 1999 while 5.4%±1.7 were deeme d well controlled in 2003. The proportion of well controlled patients in the s ub group of hypertensive patients with renal failure (cut off thresholds: 125/ 75 mmHg) remained relatively stable between 1999 and 2003: 5.2%[2.5, 7.9] ver su s 2.8%[0.5; 8.6]. Conclusion: there was a significant increase in the proport io n of well controlled hypertensive patients between 1999 and 2003. This increase occurred at the same time as a number of initiatives (scientific societies, fed eral government as well as the National Health Fund) intended to sensitize physi cians to the need to obtain adequate blood pressure control.