Clinical inertia in diagnosis and treatment of hypertension in primary care: quantification and associated factors.
OBJECTIVE
The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.


METHODS
Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia.


RESULTS
Diagnostic inertia was present in 32.5% (95% CI 31.4-33.6) and therapeutic inertia in 37.0% (95% CI 35.6-38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p<0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p<0.001) and BP values (p<0.001).


CONCLUSIONS
Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.
Gil-Guillén
Vicente
V
Departamento de Medicina Clinica, Miguel Hernández University, Elche, Alicante, Spain. atención.primaria@umh.es
Orozco-Beltrán
Domingo
D
Pérez
Rafael Peset
RP
Alfonso
Jose Luis
JL
Redón
Josep
J
Pertusa-Martínez
Salvador
S
Navarro
Jorge
J
Cea-Calvo
Luis
L
Quirce-Andrés
Fernando
F
Merino-Sánchez
Jaime
J
Carratalá
Concepción
C
Martín-Moreno
José María
JM
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003327:Coronary Disease / Q000150:complications; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D013030:Spain; D020521:Stroke / Q000150:complications; D013599:Systole