NON-COMPLIANCE OR THERAPEUTIC INERTIA AS A CAUSE OF POOR BLOOD PRESSURE CONTROL?: PP.33.305

Abstract

Objective: To evaluate the influence of physician's therapeutic inertia (TI) and the non-compliance in the blood pressure (BP) control. Design and Methods: Cross-sectional, multicenter study with review of clinical records conducted in primary care (PC) centers and specialists of Spain. Patients were hypertensive, > or =18 years old and had given their informed consent. Current and retrospective data (6, 12, 18 and 24 months) were recorded. Poor control of BP was defined when BP values were > or =140 and/or 90 mmHg. Compliance of patient was assessed through the Morisky-Green questionnaire. TI was considered the lack of treatment intensification (increased dose and/or addition of drugs and/or change of treatment due to lack of effectiveness) in patients with poor control of BP at any visit for the last 2 years. Results: 5,307 patients were included: 54.2% men, mean age 65.3 years. 22.7% had controlled current BP and 77.3% non-controlled. 75.8% had poor control of current BP and in the last two years. 2,295 patients (43.9%) were compliant and 2,923 non-compliant (56,1%) in the current visit. 13% of patients were compliant with controlled BP, 31% were compliant with non-controlled BP, 9.7% were non-compliant with controlled BP and 46.3% were non-compliant with non-controlled BP. During last 2 years, TI was observed in 80.7% of patients (86.0% in PC and 74.5% for specialists). Poor BP control without changing treatment in visits 24, 18, 12 and 6 months before was observed in 53.5%, 45.3%, 48.6% and 50.6% of patients, respectively. The TI was more common in males, non-obese and patients treated with monotherapy or two-drug therapy. Conclusions: In PC and specialist consultations, the percentage of patients achieving optimal BP values remains low. In more than five out of 10 patients shows poor compliance and eight in 10 physicians make TI. In compliant patients, there is a low rate of BP control that implies a high responsibility by physician in the lack of control.