Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors

Figures & data

Table I. Descriptive data corresponding to 33 440 subjects included in the study.

	n (%) or Mean* (SD)	95% CI
Age (years)*	54.6 (10.4)	54.5–54.8
Male	13349 (39.9%)	39.4–40.4
Body mass index (kg/m^2)*	27.8 (4.4)	27.8–27.9
Arterial hypertension	6899 (20.6%)	20.2–21.1
Systolic BP (mmHg)*	128.1 (17.5)	127.9–128.3
Diastolic BP (mmHg)*	77.7 (10.5)	77.6–77.8
Dyslipidemia	4392 (13.1%)	12.8–13.5
Total cholesterol (mg/dl)*	209.6 (37.7)	209.2–210.0
Type 2 diabetes	1980 (5.9%)	5.7–6.2
Fasting glucose (mg/dl)*	99.5 (26.4)	99.2–99.8
Smokers	7532 (22.5%)	22.1–23.0
Cardiovascular heart disease	1401 (4.2%)	4.0–4.4
Stroke	787 (2.4%)	2.2–2.5
Cardiovascular risk (SCORE table)	2.0 (2.9)	2.0–2.0
High SCORE risk	3377 (10.1%)	9.8–10.4

SD, standard deviation; BP, blood pressure.

Figure 1. Quantification of diagnostic inertia in medical check-ups. CI, confidence intervals of 95%; n=sample size; HTN, arterial hypertension. *Percentage calculated from total number of people with no history of HTN; **percentages calculated from total number of people with abnormal BP reading.

Figure 2. Quantification of therapeutic inertia in medical check-ups. CI, confidence intervals of 95%; n=sample size; HTN, arterial hypertension. *Percentages calculated from total number of people with history of HTN; **percentages calculated from total number of people with bad control.

Table IIa. Qualitative variables associated with clinical inertia; bivariate analysis.

		Diagnostic inertia			Therapeutic inertia
		n	%	p	n	%	p
Gender	Male	1043	31.1	0.011	682	35.5	0.774
	Female	1156	34.0		912	35.1
Dyslipidemia	No	1929	32.0	0.011	1046	33.3	<0.001
	Yes	270	36.6		548	39.7
Type 2 diabetes	No	2071	32.1	<0.001	1099	31.5	<0.001
	Yes	128	41.0		495	48.2
Smoker	No	1769	33.5	0.002	1410	35.5	0.377
	Yes	430	29.1		184	33.6
Coronary heart disease	No	2108	32.1	<0.001	1258	32.4	<0.001
	Yes	91	48.7		336	53.1
Stroke, %	No	2136	32.2	0.001	1437	33.9	<0.001
	Yes	63	45.7		157	56.3
CV risk by SCORE table	< 5%	1784	33.1	<0.001	810	31.5	0.993
	≥ 5%	298	26.9		361	31.5

BP, blood pressure; HT, hypertension; CV, cardiovascular.

Table IIb. Quantitative variables associated with clinical inertia; bivariate analysis.

		Diagnostic inertia			Therapeutic inertia
		Mean	SD	p	Mean	SD	p
Age	Inertia no	56.2	9.8	<0.001	62.5	9.5	0.001
	Inertia yes	57.1	9.7		63.5	9.7
SBP (mmHg)	Inertia no	147.6	13.7	<0.001	151.1	14.5	<0.001
	Inertia yes	140.4	8.6		137.8	9.7
DBP (mmHg)	Inertia no	88.3	9.4	<0.001	87.7	9.8	<0.001
	Inertia yes	82.3	7.9		80.9	7.4
Total Cholesterol (mg/dl)*	Inertia no	216.8	39.0	<0.001	211.6	36.2	0.001
	Inertia yes	213.3	37.4		207.7	35.7
Fasting glucose (mg/dl)	Inertia no	102.7	29.4	0.016	112.3	34.0	<0.001
	Inertia yes	100.9	28.2		116.9	38.2
Body Mass Index (kg/m^2)	Inertia no	29.0	4.3	<0.001	30.5	4.8	<0.001
	Inertia yes	28.3	4.1		30.3	4.7
SCORE CV risk	Inertia no	3.1	3.6	<0.001	4.7	4.6	0.001
	Inertia yes	2.6	2.9		4.2	3.6

SD, standard deviation; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; CV, cardiovascular.

Table III. Variables associated with inertia; multivariate analysis.

	OR (95% CI)	p
Diagnostic inertia
Type 2 diabetes (Yes/No)	1.32 (1.01-1.73)	0.041
Smoker (No/Yes)	1.23 (1.07-1.43)	0.004
Coronary heart disease (Yes/No)	1.90 (1.37-2.63)	0.000
Systolic BP (1 mmHg of increment)	0.94 (0.93-0.94)	0.000
Diastolic BP (1 mmHg of increment)*	0.92 (0.91-0.93)	0.000
Body mass index (1 kg/m^2 of increment)*	0.98 (0.97-1.00)	0.031
Therapeutic inertia
Type 2 diabetes (Yes/No)	1.31 (1.10-1.57)	0.003
Coronary heart disease (Yes/No)	1.31 (1.05-1.63)	0.016
Stroke (Yes/No)	1.98 (1.44-2.72)	0.000
Systolic BP (1 mmHg of increment)*	0.91 (0.90-0.92)	0.000
Diastolic BP (1 mmHg of increment)*	0.93 (0.92-0.93)	0.000

BP, blood pressure; OR, odds ratio; CI, confidence interval. Independent variables: age, gender, history of smoking, dyslipidemia, and type 2 diabetes, coronary heart disease, stroke, systolic BP and diastolic BP. *Increment above the threshold.