title: [A specific questionnaire to evaluate therapeutic inertia in hypertensive patients: a pilot study].
abstract: BACKGROUND
  Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France.
  
  
  METHODS
  This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire.
  
  
  RESULTS
  Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI.
  
  
  CONCLUSIONS
  Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
authors.affiliation: Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France. Electronic address: teodorapretorean@yahoo.fr.
authors.forename: T
authors.initials: T
authors.lastname: Pretorean
authors.affiliation: Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Claisse
authors.affiliation: Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Delsart
authors.affiliation: Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Caudrelier
authors.affiliation: Délégation à la recherche, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Devos
authors.affiliation: Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Mounier-Vehier
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001795:Blood Pressure Determination; D002309:Cardiology; D004351:Drug Resistance; D057915:Drug Substitution / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure control; Contrôle tensionnel; Hypertension; Hypertension artérielle; Inertie thérapeutique; Therapeutic inertia