American Journal of Cardiovascular Drugs

, Volume 13, Issue 3, pp 213–219

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

  • 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
Original Research Article

DOI: 10.1007/s40256-013-0025-4

Cite this article as:
Gil-Guillén, V., Orozco-Beltrán, D., Carratalá-Munuera, C. et al. Am J Cardiovasc Drugs (2013) 13: 213. doi:10.1007/s40256-013-0025-4

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.

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Vicente Gil-Guillén
    • 1
    • 2
  • Domingo Orozco-Beltrán
    • 1
    • 3
  • Concepción Carratalá-Munuera
    • 1
  • Emilio Márquez-Contreras
    • 4
  • Ramón Durazo-Arvizu
    • 5
  • Richard Cooper
    • 5
  • Salvador Pertusa-Martínez
    • 1
  • Salvador Pita-Fernandez
    • 6
  • Diego González-Segura
    • 1
  • José Luis Martin-de-Pablo
    • 4
  • Vicente Pallarés
    • 1
  • Antonio Fernández
    • 1
  • Josep Redón
    • 7
  1. 1.Cátedra de Medicina de Familia, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
  2. 2.Research UnitElda HospitalAlicanteSpain
  3. 3.Research UnitSan Juan HospitalAlicanteSpain
  4. 4.Treatment compliance and inertia research groupSpanish Society of HypertensionAlicanteSpain
  5. 5.Loyola UniversityChicagoUSA
  6. 6.A Coruña UniversityA CoruñaSpain
  7. 7.Valencia UniversityClínico Universitario HospitalValenciaSpain