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

The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.

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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  1. 10.1161/hyp.26.1.60 · DOI
  2. 10.1161/circ.95.4.1085 · DOI

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Metadata

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
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
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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