Therapeutic Inertia in the Management of Hypertension by Moroccan General Practitioners

Therapeutic inertia has been identified as a major factor in poor blood pressure control. This study aimed to investigate factors associated with therapeutic inertia in hypertension management among Moroccan General Practitioners (GPs).

A descriptive and analytical cross-sectional study was conducted from October 2021 to January 2022, involving Moroccan general practitioners using an anonymous questionnaire developed specifically for this study, covering numerous areas: their socio-demographic characteristics, assessment of hypertension knowledge, reasons not to intensify therapy, and clinical scenarios. A univariate analysis was performed using the Chi-square test to compare percentages. A multivariable logistic regression analysis was also applied to study variables possibly associated with therapeutic inertia.

A total of 130 physicians participated in this study. Most of the practitioners were female (62.3%). The median age was 32 years (IQR, 26-50). The percentage of physicians who had practiced for 5 years or less was 51.5%, compared with 48.5% who had practiced for more than 5 years. The median number of patients seen per day was estimated at 30 patients with an interquartile range of [15, 50]. The median consultation duration was 10 minutes (IQR, 5-15). Using the study-defined cutoff of ≥2, 78.5% of physicians met the criterion for therapeutic inertia (95% CI, 70.4%-85.2%). Furthermore, the two main reasons for therapeutic abstention reported by physicians were: the importance of improving patient compliance, lifestyle, and dietary measures before intensifying treatment (81.5%), in addition to the perception that office blood pressure does not reflect the patient's "true" blood pressure (BP) and therefore does not support immediate treatment intensification without further ambulatory monitoring (43.8%).

This study found a high prevalence of therapeutic inertia in primary care. The study's results found that the advanced age of the hypertensive patient was inversely related to clinical inertia. Multivariable regression showed that when the patient is diabetic, the general practitioners tend to be 4 times more 'therapeutically inert' [OR 4.42 (95% CI 1.2-7.23)]. A patient's history of ischemic stroke was also positively associated with Therapeutic Inertia (TI) [OR 1.53 (95% CI 1.23-4.23)].

Therapeutic inertia was common among participating Moroccan general practitioners and varied across clinical contexts. According to our study, the history of diabetes or stroke was positively associated with inertia. Given the exploratory nature of the study and its sampling limitations, these findings require confirmation in larger and more representative studies.