Abstract 12066: Older Age and Higher Number of Comorbidities Are Associated With Therapeutic Inertia for Blood Pressure Control

Abstract

Introduction: Therapeutic inertia, defined as failure to initiate or escalate dose of blood pressure (BP) lowering medications when BP goals are not achieved, remains a major barrier to improving BP control rates. This study examines factors associated with therapeutic inertia for hypertensive ambulatory patients receiving care in university-affiliated primary care clinics. Methods: This retrospective cohort study included 8,451 hypertensive adults age > 65 years with > 1 primary care follow-up visit within one year between January 1, 2017 and January 31, 2021. Sociodemographic and clinical data, including comorbidities of diabetes, obesity, and cardiovascular disease, were extracted from the electronic health record. Generalized linear mixed models with a binomial distribution were used to calculate adjusted odds of therapeutic inertia during a clinic visit when BP was elevated by age group (65-74, ≥ 75 years) and number of comorbidities (0, 1, 2, 3-4, > 5), after adjustment for covariates. An interaction term of age group * number of comorbidities in the adjusted model was statistically significant (P<0.001), so marginal effects were used to calculate adjusted probabilities of therapeutic inertia at a clinic visit by age group and by number of comorbidities. Results: Mean age was 75 ± 8 years old, 42% were male, and race was 72% White, 17% Black, and 11% other. Across 28,585 clinic visits when BP was elevated, mean SBP and DBP were 152 ± 13 and 78 ± 11 mmHg, respectively, and therapeutic inertia occurred in 75% (21,325) of visits. Figure 1 shows that mean adjusted probability of therapeutic inertia among adults with 0 to > 5 comorbidities ranged from 64 ± 15 % to 81 ± 12% with age 65-74 years, respectively, and 70 ± 15% to 82 ± 11% with age ≥ 75 years. Conclusions: Therapeutic inertia is common among older hypertensive adults with multiple comorbidities, and interventions are needed to address lack of medication escalation when BP remains uncontrolled.