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Is There a Predictive Profile for Clinical Inertia in Hypertensive Patients?

An Observational, Cross-Sectional, Multicentre Study

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Abstract

Background: Some studies have described a large number of hypertensive patients who are followed by a primary care physician without achieving adequate blood pressure (BP) control but whose treatment nevertheless is not intensified. It is not known whether physicians are aware of this clinical inertia and what factors are associated with this problem.

Objective: The aim of this study was to describe the factors associated with clinical inertia in hypertensive patients.

Methods: This was an observational, cross-sectional, multicentre study conducted in a network of primary care centres and hospital hypertension units in Spain. Using a consecutive sampling approach, 512 physicians selected 5077 hypertensive patients in whom they suspected poor BP control after chart review. The main variables documented were BP control and cardiovascular risk according to European Society of Hypertension guidelines, changes in treatment after visit, type of treatment, and healthcare setting. A binomial logistic regression multivariate analysis, adjusted for physician, was performed.

Results: Of the selected patients, 70.9% had poor BP control according to measurements taken in the physician’s office, and in 1499 (42.1%) of those poorly controlled patients, treatment was not intensified (clinical inertia). Factors associated with clinical inertia were as follows: being seen at a primary care centre (p<0.001), not having left ventricular hypertrophy (p<0.001) or microalbuminuria (p<0.001), taking fixed-dose (p=0.049) or free-dose (p=0.001) combination therapy, BP measured in other settings (nurse’s office, patient’s home) than the physician’s office (p=0.034) or the pharmacy (p=0.019), older age (p=0.032), and lower systolic (p<0.001) and diastolic (p<0.001) BP. Of the hypertensive patients with clinical inertia, 90.2% (95% CI 88.7, 91.7) had high cardiovascular risk.

Conclusions: Clinical inertia was associated with a profile that included older age, lack of co-morbid conditions and being seen at a primary care centre.

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Acknowledgements

The authors wish to thank all the physicians who have been involved in the INERCAP (Inercia Clínica) study and the SEH-LELHA (Sociedad Española de Hipertensión — Liga Española para la Lucha contra la Hipertensión Arterial) Compliance Group. The authors would also like to express their gratitude to Almirall S.A., Barcelona, Spain, for its unrestricted grant, which contributed to the funding of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Miguel Hernandez University, San Juan de Alicante, Spain

    Vicente Gil-Guillén (Cátedra de Medicina de Familia), Domingo Orozco-Beltrán, Diego González-Segura, Concepción Carratalá-Munuera, Vicente Pallarés, Salvador Pertusa-Martínez & Antonio Fernández

  2. Research Unit, Elda Hospital, Elda, Spain

    Vicente Gil-Guillén (Cátedra de Medicina de Familia)

  3. Research Unit, San Juan Hospital, San Juan de Alicante, Spain

    Domingo Orozco-Beltrán

  4. Treatment Compliance and Inertia Research Group, Spanish Society of Hypertension, Madrid, Spain

    Emilio Márquez-Contreras & José Luis Martín de Pablo

  5. Loyola University, Chicago, IL, USA

    Ramón Durazo-Arvizu & Richard Cooper

  6. A Coruña University, A Coruña, Spain

    Salvador Pita-Fernández

  7. Hospital Clínico Universitario, Valencia University, Valencia, Spain

    Josep Redón

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  1. Vicente Gil-Guillén
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Correspondence to Vicente Gil-Guillén.

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Gil-Guillén, V., Orozco-Beltrán, D., Márquez-Contreras, E. et al. Is There a Predictive Profile for Clinical Inertia in Hypertensive Patients?. Drugs Aging 28, 981–992 (2011). https://doi.org/10.2165/11596640-000000000-00000

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