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. 2024 Mar 15;37(4):280-289.
doi: 10.1093/ajh/hpad108.

Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure

Grant T Hiura  1 , Talar W Markossian  2 , Beatrice D Probst  1   3 , Mohammad Samie Tootooni  4 , Gregory Wozniak  5 , Michael Rakotz  5 , Holly J Kramer  2   6
Affiliations

Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure

Grant T Hiura et al. Am J Hypertens. .

Abstract

Background: Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities.

Methods: We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65-74 and ≥75 years) after covariate adjustment.

Results: Baseline mean age was 75.0 years (SD 7.8); 41.4% were male. TI occurred in 79.0% and 83.7% of clinic visits in age groups 65-74 and ≥75 years, respectively. In age group 65-74 years, prevalence ratio of TI with 2, 3-4, and ≥5 comorbidities compared with zero comorbidities was 1.07 (95% confidence interval [CI]: 1.04, 1.12), 1.08 (95% CI: 1.05, 1.12), and 1.15 (95% CI: 1.10, 1.20), respectively. The number of comorbidities was not associated with TI prevalence in age group ≥75 years. After implementation of the improvement program, TI declined from 80.3% to 77.2% in age group 65-74 years and from 85.0% to 82.0% in age group ≥75 years (P < 0.001 for both groups).

Conclusions: TI was common among older adults but not associated with comorbidities after age ≥75 years. A hypertension improvement program had limited impact on TI in older patients.

Keywords: age; blood pressure; blood pressure control; hypertension; quality improvement; therapeutic inertia.

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Conflict of interest statement

Data were presented at the American Heart Association meeting as an oral presentation in Chicago, IL, November 2022 (Abstract 12066). Dr Kramer has receiving consulting fees from Bayer Pharmaceuticals and Vifor pharmaceuticals. Drs Wozniak and Roznik are employed by the American Medical Association.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Flow chart of selection of patients age ≥65 years and older with a hypertension diagnosis receiving care in university-affiliated primary care clinics from January 2017 through March 2020).
Figure 2.
Figure 2.
Adjusted probability of therapeutic inertia by age group and by number of comorbidities during 22,665 primary care visits with uncontrolled BP defined as SBP ≥140 mm Hg and/or DBP ≥90 mm Hg among 7,415 patients with a hypertension diagnosis. Probabilities were calculated using marginal effects after using generalized linear mixed-effects models with a binomial distribution stratified by age group (65–74 and ≥75 years) and adjusted for self-reported race and ethnicity, body mass index, smoking status, clinic site, average time between visits, insurance status, marital status, classes of antihypertensive medications, hypertension severity at the clinic visit, and patient random effects. Abbreviations: BP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure.
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