Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

Insufficient awareness of hypertension guidelines byphysicians may be an impediment to achieving adequateblood pressure (BP) control rates in clinical practice. Wetherefore conducted an open intervention survey amongprimary care physicians in 1596 centres from 16 countriesin four different continents to prospectively assess whatis the BP goal defined by physicians for individualpatients and what are the reasons for not intensifyingantihypertensive treatment when BP goals are notachieved. Enrolled patients (N¼35 302) were either nottreated to goal (N¼22 887) or previously untreated(N¼12 250). Baseline systolic and diastolic BP averaged159/95±15/12mmHg. BP goals defined by physiciansaveraged 136±6mmHg for systolic and 86±5mmHg fordiastolic BP. Patients’ individual risk stratification determinedBP goals. At last visit BP averaged 132/81±11/8mmHg and values of p140/90 were reached in 92% ofuntreated and 80% of previously uncontrolled treatedhypertensives. The main reasons for not intensifyingantihypertensive treatment when BP remained above goalwere the assumption that the time after starting the newdrug was too short to attain its full effect, the satisfactionwith a clear improvement of BP or with a BP nearing thegoal, and the acceptance of good self-measurements. Inthis open intervention program in primary care, a largeproportion of patients achieved recommended BP goals.The belief that a clear improvement in BP is acceptableand that the full drug effect may take up to several weeksto be reached are frequent reasons for treatment inertiawhen goals are not achieved.Journal of Human Hypertension (2009) 23, 151–159;doi:10.1038/jhh.2008.117; published online 11 September 2008