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Factors Associated with Treatment Intensification for Uncontrolled Hypertension in a US Health System.
Jaejin An1,2, Teresa N Harrison3, Liang Ni3
1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. jaejin.x.an@kp.org.
Journal of General Internal Medicine
|December 9, 2025
Summary
Therapeutic inertia is common in hypertension management, with only 29% of patients receiving treatment intensification. Team-based BP clinics improved intensification rates, highlighting the need for targeted interventions to enhance blood pressure control.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Therapeutic inertia, a significant barrier to effective blood pressure (BP) control, necessitates investigation into factors influencing treatment intensification.
- Uncontrolled hypertension remains a major global health concern, underscoring the need for optimized management strategies.
Purpose of the Study:
- To identify demographic, clinical, and health system factors associated with treatment intensification for uncontrolled hypertension.
- To compare treatment intensification rates between in-person medical office visits and team-based BP clinic encounters.
Main Methods:
- A mixed-methods approach combining quantitative analysis of electronic health records (EHRs) and qualitative insights from 11 semi-structured provider interviews.
- Analysis of EHR data from 221,519 adult patients with uncontrolled hypertension (BP ≥ 140/90 mm Hg) at Kaiser Permanente Southern California from 2018, followed for 6 months.
- Treatment intensification was defined as increasing medication dosage or adding new antihypertensive classes; multivariable regression identified associated factors.
Main Results:
- Only 29% of patients with uncontrolled BP experienced treatment intensification.
- Older age (≥ 76 years) and diabetes were associated with lower odds of treatment intensification.
- Team-based BP clinic encounters demonstrated higher odds of treatment intensification (OR=1.23) compared to standard office visits.
- Provider interviews revealed concerns regarding side effects, medication nonadherence, and shared decision-making as key barriers to intensifying therapy.
Conclusions:
- Less than one-third of patients with uncontrolled hypertension received intensified treatment, indicating a persistent therapeutic inertia.
- Team-based BP clinics facilitate more frequent treatment intensification, suggesting their potential for improving hypertension management.
- Targeted interventions addressing identified barriers are crucial for enhancing blood pressure control and reducing cardiovascular risk.
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