Cited by 527Blood Pressure and Hypertension StudiesClinical practice guidelines implementationMedication Adherence and Compliance

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Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals

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Okonofua, Eni C., Simpson, Kit N., Jesri, Ammar, Rehman, Shakaib U., Durkalski, Valerie L., Egan, Brent M.·2006·Hypertension

DOI 10.1161/01.hyp.0000200702.76436.4b

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Abstract

Therapeutic inertia (TI), defined as the providers’ failure to increase therapy when treatment goals are unmet, contributes to the high prevalence of uncontrolled hypertension (≥140/90 mm Hg), but the quantitative impact is unknown. To address this gap, a retrospective cohort study was conducted on 7253 hypertensives that had ≥4 visits and ≥1 elevated blood pressure (BP) in 2003. A 1-year TI score was calculated for each patient as the difference between expected and observed medication change rates with higher scores reflecting greater TI. Antihypertensive therapy was increased on 13.1% of visits with uncontrolled BP. Systolic BP decreased in patients in the lowest quintile of the TI score but increased in those in the highest quintile (−6.8±0.5 versus +1.8±0.6 mm Hg; P <0.001). Individuals in the lowest TI quintile were &33 times more likely to have their BP controlled at the last visit than those in highest quintile (odds ratio, 32.7; 95% CI, 25.1 to 42.6; P <0.0001). By multivariable analysis, TI accounted for &19% of the variance in BP control. If TI scores were decreased &50%, that is, increasing medication dosages on &30% of visits, BP control would increase from the observed 45.1% to a projected 65.9% in 1 year. This study confirms the high rate of TI in uncontrolled hypertensive subjects. TI has a major impact on BP control in hypertensive subjects receiving regular care. Reducing TI is critical in attaining the Healthy People 2010 goal of controlling hypertension in 50% of all patients.

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Authors: Okonofua, E. C., Simpson, K. N., Jesri, A., Rehman, S. U., Durkalski, V. L., & Egan, B. M.
Affiliations: Medical University of South Carolina (US)
ORCID: Simpson, Kit N.
Egan, Brent M.
Venue: Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2006-03
Volume: 47
Issue: 3
Pages: 345-351
ISSN: 0194-911X (ISSN-L)
1524-4563
DOI: 10.1161/01.hyp.0000200702.76436.4b
OpenAlex: W2157629272
Cited by: 527
References: 38
Citations by year: 2026: 15 · 2025: 17 · 2024: 16 · 2023: 14 · 2022: 19 · 2021: 19 · 2020: 13 · 2019: 26 · 2018: 27 · 2017: 19 · 2016: 29 · 2015: 24 · 2014: 31 · 2013: 34 · 2012: 29
FWCI: 30.33
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Hypertension (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Health and Human Services
Medical University of South Carolina
National Institutes of Health
Agency for Healthcare Research and Quality (P01 HS1087)
National Heart, Lung, and Blood Institute (HL04290, K24HL004290, R01HL058794, HL 58794)
National Institute on Minority Health and Health Disparities (P60MD00267, P60MD000267, MD00267)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords: therapeutic inertia, uncontrolled hypertension, blood pressure control, treatment goals, Healthy People 2010, primary care, systolic blood pressure
MeSH terms: Antihypertensive Agents, Blood Pressure, Diastole, Dose-Response Relationship, Drug, Female, Goals, Humans, Hypertension, Male, Middle Aged, Physician's Role, Quality of Health Care, Retrospective Studies, Systole, Models, Statistical, Cohort Studies, Multivariate Analysis

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Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals

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