Drugs & Aging

, Volume 28, Issue 12, pp 981–992

Is There a Predictive Profile for Clinical Inertia in Hypertensive Patients?

An Observational, Cross-Sectional, Multicentre Study
  • Vicente Gil-Guillén
  • Domingo Orozco-Beltrán
  • Emilio Márquez-Contreras
  • Ramón Durazo-Arvizu
  • Richard Cooper
  • Salvador Pita-Fernández
  • Diego González-Segura
  • Concepción Carratalá-Munuera
  • José Luis Martín de Pablo
  • Vicente Pallarés
  • Salvador Pertusa-Martínez
  • Antonio Fernández
  • Josep Redón
Original Research Article

DOI: 10.2165/11596640-000000000-00000

Cite this article as:
Gil-Guillén, V., Orozco-Beltrán, D., Márquez-Contreras, E. et al. Drugs Aging (2011) 28: 981. doi:10.2165/11596640-000000000-00000

Abstract

Background: Some studies have described a large number of hypertensive patients who are followed by a primary care physician without achieving adequate blood pressure (BP) control but whose treatment nevertheless is not intensified. It is not known whether physicians are aware of this clinical inertia and what factors are associated with this problem.

Objective: The aim of this study was to describe the factors associated with clinical inertia in hypertensive patients.

Methods: This was an observational, cross-sectional, multicentre study conducted in a network of primary care centres and hospital hypertension units in Spain. Using a consecutive sampling approach, 512 physicians selected 5077 hypertensive patients in whom they suspected poor BP control after chart review. The main variables documented were BP control and cardiovascular risk according to European Society of Hypertension guidelines, changes in treatment after visit, type of treatment, and healthcare setting. A binomial logistic regression multivariate analysis, adjusted for physician, was performed.

Results: Of the selected patients, 70.9% had poor BP control according to measurements taken in the physician’s office, and in 1499 (42.1%) of those poorly controlled patients, treatment was not intensified (clinical inertia). Factors associated with clinical inertia were as follows: being seen at a primary care centre (p<0.001), not having left ventricular hypertrophy (p<0.001) or microalbuminuria (p<0.001), taking fixed-dose (p=0.049) or free-dose (p=0.001) combination therapy, BP measured in other settings (nurse’s office, patient’s home) than the physician’s office (p=0.034) or the pharmacy (p=0.019), older age (p=0.032), and lower systolic (p<0.001) and diastolic (p<0.001) BP. Of the hypertensive patients with clinical inertia, 90.2% (95% CI 88.7, 91.7) had high cardiovascular risk.

Conclusions: Clinical inertia was associated with a profile that included older age, lack of co-morbid conditions and being seen at a primary care centre.

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Vicente Gil-Guillén
    • 1
    • 2
  • Domingo Orozco-Beltrán
    • 1
    • 3
  • Emilio Márquez-Contreras
    • 4
  • Ramón Durazo-Arvizu
    • 5
  • Richard Cooper
    • 5
  • Salvador Pita-Fernández
    • 6
  • Diego González-Segura
    • 1
  • Concepción Carratalá-Munuera
    • 1
  • José Luis Martín de Pablo
    • 4
  • Vicente Pallarés
    • 1
  • Salvador Pertusa-Martínez
    • 1
  • Antonio Fernández
    • 1
  • Josep Redón
    • 7
  1. 1.Miguel Hernandez UniversitySan Juan de AlicanteSpain
  2. 2.Research UnitElda HospitalEldaSpain
  3. 3.Research UnitSan Juan HospitalSan Juan de AlicanteSpain
  4. 4.Treatment Compliance and Inertia Research GroupSpanish Society of HypertensionMadridSpain
  5. 5.Loyola UniversityChicagoUSA
  6. 6.A Coruña UniversityA CoruñaSpain
  7. 7.Hospital Clínico UniversitarioValencia UniversityValenciaSpain
  8. 8.Cátedra de Medicina de Familia, Departamento de Medicina ClínicaUniversidad Miguel HernándezSan Juan (Alicante)Spain