title: Is there a predictive profile for clinical inertia in hypertensive patients? An observational, cross-sectional, multicentre study.
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.
authors: Miguel Hernandez University, San Juan de Alicante, Spain. atencion.primaria@umh.es
authors: Vicente
authors: V
authors: Gil-Guillén
authors: Domingo
authors: D
authors: Orozco-Beltrán
authors: Emilio
authors: E
authors: Márquez-Contreras
authors: Ramón
authors: R
authors: Durazo-Arvizu
authors: Richard
authors: R
authors: Cooper
authors: Salvador
authors: S
authors: Pita-Fernández
authors: Diego
authors: D
authors: González-Segura
authors: Concepción
authors: C
authors: Carratalá-Munuera
authors: José Luis
authors: JL
authors: Martín de Pablo
authors: Vicente
authors: V
authors: Pallarés
authors: Salvador
authors: S
authors: Pertusa-Martínez
authors: Antonio
authors: A
authors: Fernández
authors: Josep
authors: J
authors: Redón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents