title: Analysing the concept of diagnostic inertia in hypertension: a cross-sectional study.
abstract: OBJECTIVE
  The aim of this study was to quantify diagnostic inertia (DI) when the physician fails to diagnose hypertension and determine its associated factors.
  
  
  METHODS
  This cross-sectional, observational study involved all patients without a diagnosis of hypertension who had their blood pressure (BP) measured at least three times during the second half of 2010 (N = 48,605). Patients with altered mean BP figures (≥ 140/90 mmHg) were considered to experience DI. Secondary variables: gender, atrial fibrillation, diabetes mellitus, dyslipidemia, cardiovascular disease, age and the physician having attended a cardiovascular training course (ESCARVAL). Associated factors were assessed by multivariate logistic regression analysis.
  
  
  RESULTS
  Diagnostic inertia was present in 6450 patients (13.3%, 95% CI: 13.0-13.6%). Factors significantly associated with DI were: male gender (OR = 1.46, 95% CI: 1.37-1.55, p < 0.001), atrial fibrillation (OR = 0.73, 95% CI: 0.58-0.92, p = 0.007), the ESCARVAL cardiovascular course (OR = 0.88, 95% CI: 0.81-0.96, p = 0.005), diabetes mellitus (OR = 0.93, 95% CI: 0.87-0.99, p = 0.016), cardiovascular disease (OR = 0.77, 95% CI: 0.67-0.88, p < 0.001) and older age (years) (18-44→OR = 1; 45-59→OR = 12.45, 95% CI: 11.11-13.94; 60-74→OR = 18.11, 95% CI: 16.30-20.12; ≥ 75→OR = 20.43, 95% CI: 18.34-22.75; p < 0.001). The multivariate model had an area under the ROC curve of 0.81 (95% CI: 0.80-0.81, p < 0.001).
  
  
  CONCLUSIONS
  This study will help clinical researchers differentiate between the two forms of DI (interpretation of a positive screening test and interpretation of positive diagnostic criteria). The results found here in patients with hypertension suggest that this problem is prevalent, and that a set of associated factors can explain the outcome well (AUC>0.80).
authors.affiliation: Health Surveillance Department, Mutual Society of Castellón, Castellón, Spain.|Department of Medicine, Jaume I University, Castellón, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Pallares-Carratalá
authors.affiliation: Internal Medicine Service, La Plana Hospital, Vila-real, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Bonig-Trigueros
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.|Research Unit, Elda General Hospital, Elda, Spain.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-5959-9631
authors.initials: A
authors.lastname: Palazón-Bru
authors.affiliation: Teaching Unit of Primary Health Care, Generalitat Valenciana, Castellón, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lorenzo-Piqueres
authors.affiliation: Health Centre of Benigánim, Generalitat Valenciana, Benigánim, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Valls-Roca
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.|Research Unit, Elda General Hospital, Elda, Spain.
authors.forename: V F
authors.initials: VF
authors.lastname: Gil-Guillen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult