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Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment

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Abstract

Background

Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians.

Objective

The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it.

Methods

An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia.

Main Outcome Measure

Clinical inertia was defined when physicians did not modify treatment despite knowing that the therapeutic target had not been reached. Clinical inertia was considered to be justified (JCI) when physicians provided an explanation for not intensifying treatment and as not justified (nJCI) when no reasons were given.

Results

JCI was observed in 30.1 % (95 % CI 27.8–32.4) of patients (n = 451) and nJCI in 69.9 % (95 % CI 67.6–72.2) (n = 1,058). JCI was associated with higher blood pressure (BP) values (both systolic and diastolic) and diabetes (p = 0.012) than nJCI. nJCI was associated with patients having an isolated increase of systolic or diastolic or high borderline BP values or cardiovascular disease.

Conclusion

Physicians provided reasons for not intensifying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and cardiovascular disease.

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Acknowledgments

The authors wish to thank all the physicians of the INERCAP study and the SEH-LELHA compliance group and Almirall S. A., for its unrestricted grant.

Conflicts of interest

The authors state no conflict of interest.

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Authors and Affiliations

  1. Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Ctra. De Valencia N332 Km 87, San Juan, 03550, Alicante, Spain

    Vicente Gil-Guillén, Domingo Orozco-Beltrán, Concepción Carratalá-Munuera, Salvador Pertusa-Martínez, Diego González-Segura, Vicente Pallarés & Antonio Fernández

  2. Research Unit, Elda Hospital, Alicante, Spain

    Vicente Gil-Guillén

  3. Research Unit, San Juan Hospital, Alicante, Spain

    Domingo Orozco-Beltrán

  4. Treatment compliance and inertia research group, Spanish Society of Hypertension, Alicante, Spain

    Emilio Márquez-Contreras & José Luis Martin-de-Pablo

  5. Loyola University, Chicago, IL, USA

    Ramón Durazo-Arvizu & Richard Cooper

  6. A Coruña University, A Coruña, Spain

    Salvador Pita-Fernandez

  7. Valencia University, Clínico Universitario Hospital, Valencia, Spain

    Josep Redón

Authors
  1. Vicente Gil-Guillén
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  2. Domingo Orozco-Beltrán
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  12. Antonio Fernández
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Corresponding author

Correspondence to Vicente Gil-Guillén.

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Gil-Guillén, V., Orozco-Beltrán, D., Carratalá-Munuera, C. et al. Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment. Am J Cardiovasc Drugs 13, 213–219 (2013). https://doi.org/10.1007/s40256-013-0025-4

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  • DOI: https://doi.org/10.1007/s40256-013-0025-4

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