Hypertension Protocols Curb Racial Bias in Therapeutic Inertia

Therapeutic inertia regarding intensification of blood pressure treatment has been shown to be more of an issue in Black patients, but this was not the case in the SPRINT trial, which involved a strict standardized approach to blood pressure management, a new analysis shows.

“Overall, we found that therapeutic inertia was similar in different races in the SPRINT trial. We did not see disparities that have been reported in previous observational studies,” lead author, Alexander Zheutlin, MD, University of Utah School of Medicine, Salt Lake City, told theheart.org | Medscape Cardiology.

“These results show that a well-resourced approach in which a standardized approach to blood pressure measurement and treatment intensification is followed can overcome the racial disparity that is seen in therapeutic inertia and the treatment of blood pressure,” he added.

The study was published online in JAMA Network Open on January 10.

The authors explain that hypertension remains a leading modifiable cause of racial disparities in cardiovascular disease. Despite similar treatment rates and increased availability of safe, effective, and affordable antihypertensive medications, blood pressure control rates among Black and Hispanic adults remain significantly lower than among White adults in the United States, and one of the factors contributing to this is thought to be therapeutic inertia — the phenomenon of clinicians not initiating or up-titrating clinically indicated therapy in the setting of unmet treatment goals.

The current analysis of the SPRINT trial was conducted to investigate whether racial and ethnic differences in therapeutic inertia in hypertension were present when blood pressure care was standardized and protocolized.

The landmark SPRINT trial compared intensive (

Results showed that the overall prevalence of therapeutic inertia — defined as no antihypertensive medication intensification at each study visit where the blood pressure was above target goal — was either similar or lower for Black and Hispanic participants than for White participants. This pattern was observed whether participants were randomized to the standard or intensive treatment group.

“These findings support the idea that a standardized approach to blood pressure management, as implemented in SPRINT, may help ensure equitable care is provided to all patients and could reduce the contribution of therapeutic inertia to disparities in uncontrolled blood pressure,” the authors say.

They point out that therapeutic inertia has been identified as a key clinician-level barrier to blood pressure control and is estimated to be present in more than 80% of clinic visits in community practice, whereas in the current analysis of the SPRINT trial, therapeutic inertia was present in 50% to 60% of participant visits with uncontrolled blood pressure.

“In SPRINT, blood pressure had to be measured at defined intervals with a specific method, and there were clear instructions on intensifying treatment if blood pressure was above a certain goal,” Zheutlin noted. “Our results show that within such strict confines, therapeutic inertia does not seem to be different between different racial groups. This suggests that we could make better gains in blood pressure control and more equitable treatment if we adopted a standardized approach to hypertension management.”

He added: “Many guidelines have been published on when to start treatment and the targets for blood pressure, but there is a lot of variation in how we turn these guidelines into protocols. We need to bring in more consistent protocols on blood pressure measurement and intensification, and ensure they are followed. In practice, if the BP is 5 or 10 mm Hg above target, a clinician may defer a decision to intensify treatment and intensification never gets done. But if there was a strict protocol to follow there would be less chance of this happening.”

Therapeutic Inertia Still High

In an accompanying commentary, Matthew Rivara, MD, Nisha Bansal, MD, and Bessie Young, MD, University of Washington, Seattle, say the current SPRINT analysis has broad implications for reducing racial and ethnic disparities in achievement of evidence-based treatment targets in the general population.

“In hypertension management, standardized protocols for medication adjustments may limit clinician practice heterogeneity to ultimately reduce differences in blood pressure control among racial and ethnic minority populations,” they write. But they add that such protocols must be implemented thoughtfully to incorporate individualized clinical assessment and clinician-patient shared decision-making.

Rivara at el point out that the rates of therapeutic inertia in SPRINT, while lower than community-based estimates, were still very high. They suggest reasons for this could include clinician concerns about medication efficacy, adverse effects, and patient mistrust of medical professionals. Outside the clinical trial environment, additional considerations may include prescription drug and laboratory test costs, pharmacy access, and competing demands during busy clinic visits.

To address these challenges, they say that clinicians need education on current clinical practice guidelines, how to manage complications of intensified antihypertensive therapies, and training on shared decision-making, including culturally sensitive collaborative care. Similarly, care systems must support patients on how to address concerns about treatments.

Finally, further research is needed to better define the specific factors associated with therapeutic inertia to allow tailored interventions to overcome this inertia.

“In designing and performing such research, it is vital that investigators engage with racial and ethnic minority groups to better explore the intersection of race, ethnicity, therapeutic decision-making, trust, and shared decision-making,” they add.

The SPRINT trial was funded with federal funds from the National Institutes of Health (NIH). Zheutlin reported receiving grants from the NIH during the conduct of the study.

JAMA Network Open. Published online January 10, 2022. Full text, Commentary

Note: This article have been indexed to our site. We do not claim legitimacy, ownership or copyright of any of the content above. To see the article at original source Click Here

Related Posts
מחקר: ביומרקרים בדם עשויים להבחין בין הפרעות דמנציה שונות thumbnail

מחקר: ביומרקרים בדם עשויים להבחין בין הפרעות דמנציה שונות

סמנים ביולוגיים (ביומרקרים) בדם עשויים לסייע להבחין בין סוגי דמנציה שונים ולעקוב אחרי השינוי במחלה לאורך זמן. כך לפי מחקר חדש שפורסם בכתב העת Neurology Neurosurgery and Psychiatry. לפי החוקרים מאוניברסיטת קיימברידג' בבריטניה שערכו את המחקר הממושך, הביומרקרים מבחינים בין פרופילים שונים של מחלת אלצהיימר, דמנציה פרונטו-טמפורלית, מחלת גופיפי לואי ומחלות עצביות ניווניות. בקרב המבוגרים…
Read More
Carrot and spice quick bread thumbnail

Carrot and spice quick bread

By Mayo Clinic Staff Dietitian's tip: Carrots are an excellent source of vitamin A. Number of servings Serves 17Healthy carbLow Sodium Ingredients 1/2 cup sifted all-purpose flour 1 cup whole-wheat flour 2 teaspoons baking powder 1/2 teaspoon baking soda 1/2 teaspoon ground cinnamon 1/4 teaspoon ground ginger 1/3 cup canola oil 1/4 cup, plus 2…
Read More
FDA Finalizes Limit on How Much Arsenic Can Be in Apple Juice thumbnail

FDA Finalizes Limit on How Much Arsenic Can Be in Apple Juice

Please enable cookies. Error 1005 Ray ID: 7e97a7ba5ca4f3d1 • 2023-07-20 02:08:14 UTC What happened? The owner of this website (www.webmd.com) has banned the autonomous system number (ASN) your IP address is in (47583) from accessing this website. Was this page helpful? Thank you for your feedback! Cloudflare Ray ID: 7e97a7ba5ca4f3d1 • Your IP: •
Read More
Allscripts to sell hospital and large physician practice assets thumbnail

Allscripts to sell hospital and large physician practice assets

Allscripts announced on Wednesday that it had entered into an agreement with Toronto-based Constellation Software's N. Harris Computer Corporation to acquire the net assets of the electronic health record vendor's hospital and large physician practice business segment.   The segment includes Allscripts' Sunrise, Paragon, TouchWorks, Opal and dbMotion tools.    The assets of Allscripts Veradigm analytics…
Read More
Index Of News
Consider making some contribution to keep us going. We are donation based team who works to bring the best content to the readers. Every donation matters.
Donate Now

Subscription Form

Liking our Index Of News so far? Would you like to subscribe to receive news updates daily?