Prevalence of True Therapeutic Inertia in Blood Pressure Control in an Academic Chronic Kidney Disease Clinic

Abstract

Therapeutic inertia (TI) in blood pressure (BP) control has been traditionally defined as failure to initiate or intensify therapy when treatment goals are not met. The fallacy with this definition is that TI may be overestimated because it includes hypertensive patients deliberately uncontrolled. This is a retrospective chart review study that evaluated physicians' response to an uncontrolled clinic BP reading in a population of patients with stage 3 to 5 chronic kidney disease (CKD) and hypertension. Of 429 patients screened, 166 had controlled BP and 263 did not. Of these 263 patients, 115 patients had no clear reason documented for the absence of changes in medication regimen. This population was defined as cases with true TI. In the remaining 148 patients, the medication regimen was changed in 81 patients. In the rest of the patients, there was a reason documented for not changing the medication regimen. The prevalence of true TI rate (defined as percentage of uncontrolled hypertension as a result of physician inaccountability) in our study was 44% as compared with 69% if the traditional TI definition is applied. Thus, we conclude that the prevalence of TI in the literature overestimates the rate of true TI as it does not account for physician decision making. The current definition of TI in BP control needs to be revised, as it underestimates a provider's care to improve BP control and is misleading. The TI definition should include some mechanism to account for interventions beyond medication titration.

Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study

“…Overall, therapeutic inertia occurred in one-third of patients of our cohort; a similar frequency has been detected for erythropoiesis stimulating agents (ESA) treatment and antihypertensive drugs in renal clinics [4,17]. This phenomenon was more frequent for the treatment of hyperphosphatemia (Fig.…”

“…This is particularly important for physicians when findings derived from selected cohorts of randomized clinical trials are applied to an unselected CKD population requiring individualized strategies which must take into account the interaction between the single out-oftarget factor and the whole spectrum of the patient's comorbidities [13]. Second, knowledge about the use of MBD medications makes it possible to identify opportunities for improving care by limiting therapeutic inertia, a phenomenon described in the nephrology setting in relation to hypertension, anemia and lipid management [4,17,18]. Finally, identification of CKD-MBD treatment patterns in nationally representative outpatient nephrology settings may also help to design evidence-based algorithms by identifying the variations in physician prescriptions for ND-CKD and the reasons for such variations.…”

Evolution of therapy inertia in primary care setting in Spain during 2002–2010

“…In a national, multicenter, observational, and cross-sectional study in primary care and specialist (hospital) physicians, therapeutic inertia occurred in 75% of the consultations in which treatment change was indicated [16]. In a study performed in an academic chronic kidney disease, therapeutic inertia was found in 44% of patients [33].…”

Hypertension Guidances Published in 2013: A Busy Year With More to Follow

“…One of these is physician adherence to the prescribing recommendations in whichever guideline(s) they choose to read. Physician adherence is far from optimal in numerous geographic regions, and therapeutic inertia is widely discussed in the literature . Another is patient adherence to prescribed treatment regimens .…”