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American Journal of Cardiovascular Drugs

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01-06-2013 | Original Research Article

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

Authors: Vicente Gil-Guillén, Domingo Orozco-Beltrán, Concepción Carratalá-Munuera, Emilio Márquez-Contreras, Ramón Durazo-Arvizu, Richard Cooper, Salvador Pertusa-Martínez, Salvador Pita-Fernandez, Diego González-Segura, José Luis Martin-de-Pablo, Vicente Pallarés, Antonio Fernández, Josep Redón

Published in: American Journal of Cardiovascular Drugs | Issue 3/2013

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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Title: Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment
Authors: Vicente Gil-Guillén
Domingo Orozco-Beltrán
Concepción Carratalá-Munuera
Emilio Márquez-Contreras
Ramón Durazo-Arvizu
Richard Cooper
Salvador Pertusa-Martínez
Salvador Pita-Fernandez
Diego González-Segura
José Luis Martin-de-Pablo
Vicente Pallarés
Antonio Fernández
Josep Redón
Publication date: 01-06-2013
Publisher: Springer International Publishing AG
Published in: American Journal of Cardiovascular Drugs / Issue 3/2013
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI: https://doi.org/10.1007/s40256-013-0025-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Objective

Methods

Main Outcome Measure

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Main Outcome Measure

Results

Conclusion

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