Published Online
on January 23, 2006

A more recent version of this article appeared on March 1, 2006

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Submitted on June 28, 2005
Revised on July 21, 2005

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

Eni C. Okonofua^*; Kit N. Simpson; Ammar Jesri; Shakaib U. Rehman; Valerie L. Durkalski; and Brent M. Egan

From the Medical University of South Carolina (E.C.O., K.N.S., A.J., V.L.D., B.M.E.), and Ralph H. Johnson Veterans Affairs Medical Center (S.U.R.), Charleston, SC.

^* To whom correspondence should be addressed. E-mail: okonofua{at}musc.edu.

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.

Key words: population • antihypertensive agents • blood pressure monitoring • compliance • blood pressure • hypertension, arterial

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