Control of therapeutic inertia in the treatment of arterial hypertension by using different strategies

Objective: To evaluate the efficacy of different interventions on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT). Design: Controlled, randomised clinical trial. Setting: Two hundred clinics in 5 primary care centres. Spain. Participants: A total of 1104 patients with uncontrolled hypertension were included. Intervention: Four groups with 276 patients were formed: 1) Control group (CG): standard health intervention; 2) Education intervention and a program of home blood pressure monitoring (HBPM) (EG); 3) Card control intervention and HBPM programme (CHG); 4) Education intervention, card control and HBPM programme (ECHG). Main measurements: TI was calculated by the rate: (Number of patients whose pharmacological treatment was not changed in each visit/Number of patients with an average BP >= 140 mmHg and/or >= 90 mmHg in the general population or >= 130 and/or 90 mmHg in diabetics). The mean BPs and the percentage of controlled patients were calculated. The mean number of people that required an intervention in order to avoid TI was calculated (NI). Results: A total of 921 patients completed the study, and 1842 visits were made, with TI in 36.8% (IC = 5.8%) of the sample and in 82.58% (IC = 8.2%) of the uncontrolled hypertensive patients. The TI was 60% (CI = 4.2%), 38.4% (CI = 4.4%) 30.2 (CI = 4.3%) and 14.7 (CI = 3.3%) (p = 0.001) for CG, EG, CHG and ECHG, respectively. The percentage controlled at the end of study was 35.3% (Cl = 1.1%), 54.7% (CI = 1.8%), 60.2% (CI = 2.1%) and 65.1% (CI = 2.2%) (p<0.01) for CG, EG, CHG and ECHG, respectively. The NI were 4.6, 3.3 and 2.2 for CG, EG, CHG and ECHG, respectively. Conclusions: TI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI. (C) 2008 Elsevier Espana, S.L. All rights reserved.