title: Barriers to optimal hypertension control.
abstract: 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.
authors.affiliation: Department of Medicine ,Columbia University, New York, NY 10032, USA. goo1@columbia.edu
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
mesh_terms: 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
references.citation: N Engl J Med. 1998 Dec 31;339(27):1957-63
references.pmid: 9869666
references.citation: J Clin Epidemiol. 2002 Jul;55(7):728-35
references.pmid: 12160922
references.citation: J Hypertens. 2004 Oct;22(10):1849-55
references.pmid: 15361751
references.citation: Am J Manag Care. 2004 Jul;10(7 Pt 2):481-6
references.pmid: 15298234
references.citation: BMJ. 2003 Jun 14;326(7402):1314-5
references.pmid: 12805171
references.citation: Ann Intern Med. 2001 Nov 6;135(9):825-34
references.pmid: 11694107
references.citation: Arch Intern Med. 2003 Mar 24;163(6):681-7
references.pmid: 12639200
references.citation: N Engl J Med. 2001 Aug 16;345(7):479-86
references.pmid: 11519501
references.citation: Arch Intern Med. 2002 Feb 25;162(4):413-20
references.pmid: 11863473
references.citation: Ethn Dis. 2004 Winter;14(1):3-12
references.pmid: 15002917
references.citation: Am Heart J. 2005 May;149(5):785-94
references.pmid: 15894958