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

To determine the therapeutic behavior of primary care physicians in uncontrolled hypertensive patients in Spain during the last decade.

Data were taken from three cross-sectional surveys aimed to determine the blood pressure (BP) control rates in treated hypertensive patients followed in a setting of primary care in Spain during 2002, 2006, and 2010, respectively. Adequate BP control was globally defined as BP lower than 140/90 mmHg for the hypertensive population in the three studies. In patients with diabetes, chronic kidney disease, or cardiovascular disease, BP control was established as lower than 130/85 mmHg in PRESión arterial en la población Española en los Centros de Atención Primaria (PRESCAP) 2002 and lower than 130/80 mmHg in PRESCAP 2006 and 2010.

A total of 12, 754, 10, 520, and 12, 961 patients were included in PRESCAP 2002, 2006, and 2010 studies. Of them, 36.1, 41.4, and 46.3%, respectively, achieved BP targets. In those patients with uncontrolled BP, physicians modified the treatment in 18.3, 30.4, and 41.4% of the cases, respectively (P = 0.0001). The most frequent action taken was the change to another drug in PRESCAP 2002 (47.0%), and the addition of other antihypertensive agent in PRESCAP 2006 and 2010 (46.3 and 55.6%, respectively). Predictors of therapeutic inertia were the physicians' perception of BP control, being on treatment with combined therapy, and the absence of risk factors or cardiovascular disease.

Although therapeutic inertia has decreased in the last years in primary care setting in Spain, nowadays in nearly 60% of patients with uncontrolled BP, no therapeutic action is actually taken. Therefore, despite a significant improvement, therapeutic inertia still remains a relevant clinical problem in hypertension general practice.