THERAPEUTIC INERTIA WHEN MANAGING HIGH-NORMAL BLOOD PRESSURE LEVELS IN PATIENTS AT HIGH CARDIOVASCULAR RISK. A STUDY ON PRIMARY-CARE PHYSICIANS’ ATTITUDE: PP.33.333

Abstract

Objectives: 1)To asses the magnitude of clinical inertia when managing high-normal blood pressure (BP) levels in patients at high cardiovascular (CV) risk; and 2) To analyse physician and patient factors underlying clinical inertia. Design and Methods: An anonymous survey was conducted in primary-care physicians of Madrid in order to assess their attitude towards initiation or intensification of antihypertensive medications in a set of four hypothetical clinical cases. Physicians demographic features and primary-care-centres characteristics were analysed. Each case described a situation in which a patient at high CV risk had high-normal BP levels (BP:135–139/85–89 mmHg). The cases were characterised by one of the following clinical features: 1) metabolic syndrome;2) type II diabetes; 3) moderate renal insufficiency due to glomerulosclerosis; and 4) ischemic stroke. Physicians were asked to decide whether or not to initiate or intensify a previous treatment and otherwise give reasons for not modifying it. Results: Two hundred and seventy-five physicians participated. Overall, the physicians decided to initiate or intensify a previous treatment in 2.5 ± 0.7 cases. Physicians' attitude was very different depending on the clinical cases: Most physicians (87%) decided to intensify the treatment in the renal insufficiency case, while only 47% of them did so in the metabolic syndrome case. Most doctors who did not modify the previous treatment (74%) argued that clinic BP might not reflect “real life” BP. The remaining 26% doctors considered that patients' BP values were acceptable. CV Working Group membership and routine use of CV stratification risk were both associated (p < 0.05) with a more “aggressive” therapeutic attitude. Conclusions: 1) Our results suggest an important therapeutic inertia when managing high-normal BP at primary care settings. However, they might not reflect what physicians actually decide in the real clinical setting. 2) The degree of clinical inertia is influenced by physician factors (routine use to stratification risk tables and membership to CV working groups) and patient factors (specific clinical features related with CV risk).