Barriers to optimal hypertension control.
There is an obvious gap in the translation of clinical trial evidence into practice with regards to optimal hypertension control. The three major categories of barriers to BP control are patient-related, physician-related, and medical environment/health care system factors. Patient-related barriers include poor medication adherence, beliefs about hypertension and its treatment, depression, health literacy, comorbidity, and patient motivation. The most pertinent is medication adherence, given its centrality to the other factors. The most salient physician-related barrier is clinical inertia--defined, as the failure of health care providers to initiate or intensify drug therapy in a patient with uncontrolled BP. The major reasons for clinical inertia are: 1) overestimation of the amount of care that physicians provide; 2) lack of training on how to attain target BP levels; and 3) clinicians' use of soft reasons to avoid treatment intensification by adopting a "wait until next visit" approach in response to patients' excuses.
Ogedegbe
Gbenga
G
Department of Medicine ,Columbia University, New York, NY 10032, USA. goo1@columbia.edu
D001294:Attitude to Health; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D010349:Patient Compliance; D011320:Primary Health Care
N Engl J Med. 1998 Dec 31;339(27):1957-63
9869666
J Clin Epidemiol. 2002 Jul;55(7):728-35
12160922
J Hypertens. 2004 Oct;22(10):1849-55
15361751
Am J Manag Care. 2004 Jul;10(7 Pt 2):481-6
15298234
BMJ. 2003 Jun 14;326(7402):1314-5
12805171
Ann Intern Med. 2001 Nov 6;135(9):825-34
11694107
Arch Intern Med. 2003 Mar 24;163(6):681-7
12639200
N Engl J Med. 2001 Aug 16;345(7):479-86
11519501
Arch Intern Med. 2002 Feb 25;162(4):413-20
11863473
Ethn Dis. 2004 Winter;14(1):3-12
15002917
Am Heart J. 2005 May;149(5):785-94
15894958