Despite some progress, global surveys consistently indicate that a proportion of patients with hypertension—ranging from 38% to 54%—either go undiagnosed or, when diagnosed, are not adequately treated, leaving their blood pressure uncontrolled, according to a recent commentary.
The commentary, published in JAMA Network Open, discussed physician adherence to clinical guidelines in the management of hypertension. Despite the well-established risks associated with elevated blood pressure (BP), such as heart failure, myocardial infarction, and stroke, a notable proportion of patients may remain either untreated or inadequately treated. The issue may be linked to clinical inertia, in which clinicians fail to initiate or escalate treatment despite clear indications of uncontrolled hypertension.
Investigators conducted a content analysis of electronic health records from 100 patients who presented with elevated BP at two consecutive outpatient visits without a new antihypertensive prescription within 90 days. The analysis identified multiple scenarios contributing to suboptimal adherence, categorized into clinician-, patient-, and clinical complexity–related factors. Common reasons for nonintervention included hypertension not being the primary reason for the visit and the belief that the patient’s primary care physician should manage the condition.
The commentary noted that clinical inertia is an ongoing challenge in achieving optimal BP control. While interventions such as physician reminders, out-of-office BP monitoring, and educational programs have shown some effectiveness in addressing clinical inertia, the investigators proposed the need for broader strategies. These included simplifying treatment regimens, enhancing the accessibility of clinical guidelines, and promoting team-based care models that involve other health care professionals like nurses, pharmacists, and dietitians.
The investigators concluded that each patient visit may present an opportunity to improve BP control, noting the importance of consistent action by clinicians in managing elevated BP.
No conflicts of interest were reported.