Top

Published in:

01-01-2018 | Implementation to Increase Blood Pressure Control: What Works? (J Brettler and K Reynolds, Section Editors)

Therapeutic Inertia and Treatment Intensification

Authors: Robina Josiah Willock, Joseph B. Miller, Michelle Mohyi, Ahmed Abuzaanona, Meri Muminovic, Phillip D. Levy

Published in: Current Hypertension Reports | Issue 1/2018

Abstract

Purpose of Review

This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations.

Recent Findings

Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia. Furthermore, programs that utilize non-physician medical professionals such as pharmacists and nurses demonstrate promise in mitigating the effects of this important problem.

Summary

Therapeutic inertia impedes antihypertensive management and requires a broad effort to reduce its effects. There is an ongoing need for renewed focus and research in this area to improve hypertension control.

Lebeau JP, Cadwallader JS, Aubin-Auger I, Mercier A, Pasquet T, Rusch E, et al. The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review. BMC Fam Pract. 2014;15(1):130. https://doi.org/10.1186/1471-2296-15-130.CrossRefPubMedPubMedCentral

• Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339(27):1957–63. https://doi.org/10.1056/NEJM199812313392701. This article is an excellent introduction to the concept of therapeutic inertia.CrossRefPubMed

Grant RW, Cagliero E, Dubey AK, Gildesgame C, Chueh HC, Barry MJ, et al. Clinical inertia in the management of Type 2 diabetes metabolic risk factors. Diabet Med. 2004;21(2):150–5. https://doi.org/10.1111/j.1464-5491.2004.01095.x.CrossRefPubMed

Mu L, Mukamal KJ. Treatment intensification for hypertension in US ambulatory medical care. J Am Heart Assoc. 2016;5(10):e004188. https://doi.org/10.1161/JAHA.116.004188.CrossRefPubMedPubMedCentral

Wallenius SH, Vainio KK, Korhonen MJ, Hartzema AG, Enlund HK. Self-initiated modification of hypertension treatment in response to perceived problems. Ann Pharmacother. 1995;29(12):1213–7. https://doi.org/10.1177/106002809502901204.CrossRefPubMed

Mancia G, Grassi G. Aggressive blood pressure lowering is dangerous: the J-curve: pro side of the argument. Hypertension. 2013;63(1):29–36. https://doi.org/10.1161/HYPERTENSIONAHA.113.01922.CrossRef

Reed WG, Anderson RJ. Effects of rapid blood pressure reduction on cerebral blood flow. Am Heart J. 1986;111(1):226–8. https://doi.org/10.1016/0002-8703(86)90585-5.CrossRefPubMed

• Levy PD, Willock RJ, Burla M, Brody A, Mahn J, Marinica A, et al. Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction. J Am Soc Hypertens. 2016;10(12):906–16. https://doi.org/10.1016/j.jash.2016.10.005. This article introduces the therapeutic intensity score as a method of estimating the treatment effect of an antihypertensive regimen.CrossRefPubMedPubMedCentral

Faria C, Wenzel M, Lee KW, Coderre K, Nichols J, Belletti DA. A narrative review of clinical inertia: focus on hypertension. J Am Soc Hypertens. 2009;3(4):267–76. https://doi.org/10.1016/j.jash.2009.03.001.CrossRefPubMed

10.

Holland N, Segraves D, Nnadi VO, Belletti DA, Wogen J, Arcona S. Identifying barriers to hypertension care: implications for quality improvement initiatives. Dis Manag. 2008;11(2):71–7. https://doi.org/10.1089/dis.2008.1120007.CrossRefPubMed

11.

Maddox TM, Ross C, Tavel HM, Lyons EE, Tillquist M, Ho PM, et al. Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients. Circ Cardiovasc Qual Outcomes. 2010;3(4):347–57. https://doi.org/10.1161/circoutcomes.110.957308.CrossRefPubMedPubMedCentral

12.

Rose AJ, Berlowitz DR, Manze M, Orner MB, Kressin NR. Comparing methods of measuring treatment intensification in hypertension care. Circ Cardiovasc Qual Outcomes. 2009;2(4):385–91. https://doi.org/10.1161/circoutcomes.108.838649.CrossRefPubMedPubMedCentral

13.

Daugherty SL, Powers JD, Magid DJ, Masoudi FA, Margolis KL, O'Connor PJ, et al. The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension. Hypertension. 2012;60(2):303–9. https://doi.org/10.1161/HYPERTENSIONAHA.112.192096.CrossRefPubMedPubMedCentral

14.

•• James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama. 2014;311(5):507–20. https://doi.org/10.1001/jama.2013.284427. The JNC 8 guidelines inform the standard of care for antihypertensive initiation and titration.CrossRefPubMed

15.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219. https://doi.org/10.1093/eurheartj/eht151.CrossRefPubMed

16.

Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, et al. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich, Conn). 2002;4(6):393–404.CrossRef

17.

Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents. A meta-analysis. Hypertension. 2010;55(2):399–407. https://doi.org/10.1161/hypertensionaha.109.139816.CrossRefPubMed

18.

Claxton AJ, Cramer J, Pierce CA. Systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296–310. https://doi.org/10.1016/S0149-2918(01)80109-0.CrossRefPubMed

19.

Feldman RD, Zou GY, Vandervoort MK, Wong CJ, Nelson SA, Feagan BG. A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial. Hypertension. 2009;53(4):646–53. https://doi.org/10.1161/HYPERTENSIONAHA.108.123455.CrossRefPubMed

20.

• Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA. 2013;310(7):699–705. https://doi.org/10.1001/jama.2013.108769. This study demonstrated the efficacy of a large-scale quality improvement program in Northern California.CrossRefPubMedPubMedCentral

21.

• Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003;326(7404):1427–0. https://doi.org/10.1136/bmj.326.7404.1427. This is a major meta-analysis that demonstrated the value of combination pill treatment.CrossRefPubMedPubMedCentral

22.

Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825–34. https://doi.org/10.7326/0003-4819-135-9-200111060-00012.CrossRefPubMed

23.

Sim JJ, Handler J, Jacobsen SJ, Kanter MH. Systemic implementation strategies to improve hypertension: the Kaiser Permanente Southern California experience. Can J Cardiol. 2014;30(5):544–52. https://doi.org/10.1016/j.cjca.2014.01.003.CrossRefPubMed

24.

Shaw RJ, McDuffie JR, Hendrix CC, Edie A, Lindsey-Davis L, Nagi A, et al. Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Ann Intern Med. 2014;161(2):113–21. https://doi.org/10.7326/M13-2567.CrossRefPubMed

25.

• He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, Dolan J, et al. Effect of a community health worker–led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017;318(11):1016–25. https://doi.org/10.1001/jama.2017.11358. This trial demonstrates the effectiveness of community health workers as leaders in implementing a blood pressure control program in low-income patients.CrossRefPubMedPubMedCentral

26.

EuroPharm Forum and World Health Organization CINDI Programme. Pharmacy-based hypertension management model: protocol and guidelines. World Health Organization. 2005. http://apps.who.int/iris/bitstream/10665/107638/1/E85730.pdf. Accessed 24 Oct 2017.

27.

Tsuyuki RT, Houle SK, Charrois TL, Kolber MR, Rosenthal MM, Lewanczuk R, et al. Randomized trial of the effect of pharmacist prescribing on improving blood pressure in the community: the Alberta Clinical Trial In Optimizing Hypertension (RxACTION). Circulation. 2015;132(2):93–100. https://doi.org/10.1161/CIRCULATIONAHA.115.015464.CrossRefPubMed

28.

McLean DL, McAlister FA, Johnson JA, King KM, Makowsky MJ, Jones CA, et al. A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: study of cardiovascular risk intervention by pharmacists-hypertension (SCRIP-HTN). Arch Intern Med. 2008;168(21):2355–61. https://doi.org/10.1001/archinte.168.21.2355. CrossRefPubMed

29.

•• Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, Kadrmas HM, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56. https://doi.org/10.1001/jama.2013.6549. This trial demonstrated the efficacy of pharmacist management in improving blood pressure control.CrossRefPubMedPubMedCentral

30.

Polgreen LA, Han J, Carter BL, Ardery GP, Coffey CS, Chrischilles EA, et al. Cost-effectiveness of a physician-pharmacist collaboration intervention to improve blood pressure control. Hypertension. 2015;66(6):1145–51. https://doi.org/10.1161/HYPERTENSIONAHA.115.06023.PubMedPubMedCentral

31.

Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffe P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3(2):e000718. https://doi.org/10.1161/JAHA.113. CrossRefPubMedPubMedCentral

32.

Petersen LA, Simpson K, Pietz K, Urech TH, Hysong SJ, Profit J, et al. Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA. 2013;310(10):1042–50. https://doi.org/10.1001/jama.2013.276303.CrossRefPubMedPubMedCentral

33.

Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ. 2011;342(jan25 3):d108. https://doi.org/10.1136/bmj.d108.CrossRefPubMedPubMedCentral

34.

Foskett-Tharby R, Nick H, Gill P. Pay for performance and the management of hypertension. J Transl Int Med. 2016;4(1):14–9. https://doi.org/10.1515/jtim-2016-0004.CrossRefPubMedPubMedCentral

35.

Fiscella K, Ogedegbe G, He H, Carroll J, Cassells A, Sanders M, et al. Blood pressure visit intensification study in treatment: trial design. Am Heart J. 2015;170(6):1202–10. https://doi.org/10.1016/j.ahj.2015.08.022.CrossRefPubMedPubMedCentral

36.

ClinicalTrials.gov. MI-BP: mHealth to Improve Blood Pressure Control in Hypertensive African Americans (NCT02955537). 2017. https://clinicaltrials.gov/ct2/show/NCT02955537?term=buis&draw=1&rank=5. Accessed 24 Oct 2017.

Title: Therapeutic Inertia and Treatment Intensification
Authors: Robina Josiah Willock
Joseph B. Miller
Michelle Mohyi
Ahmed Abuzaanona
Meri Muminovic
Phillip D. Levy
Publication date: 01-01-2018
Publisher: Springer US
Published in: Current Hypertension Reports / Issue 1/2018
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI: https://doi.org/10.1007/s11906-018-0802-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 1/2018

The Interactions of the Immune System and the Brain in Hypertension

Optimizing Hypertensive Acute Heart Failure Management with Afterload Reduction

Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension

Role of Thioredoxin in Age-Related Hypertension

Possible Breathing Influences on the Control of Arterial Pressure After Sino-aortic Denervation in Rats

Pheochromocytomas and Hypertension

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials