Gil-Guillén Vicente, Orozco-Beltrán Domingo, Pérez Rafael Peset, Alfonso Jose Luis, Redón Josep, Pertusa-Martínez Salvador, Navarro Jorge, Cea-Calvo Luis, Quirce-Andrés Fernando, Merino-Sánchez Jaime, Carratalá Concepción, Martín-Moreno José María
Departamento de Medicina Clinica, Miguel Hernández University, Elche, Alicante, Spain.
Blood Press. 2010 Feb;19(1):3-10. doi: 10.3109/08037050903350762.
The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.
Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia.
Diagnostic inertia was present in 32.5% (95% CI 31.4-33.6) and therapeutic inertia in 37.0% (95% CI 35.6-38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p<0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p<0.001) and BP values (p<0.001).
Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.
本研究的目的是量化高血压诊断和治疗中的惰性，并识别与患者相关的变量。
在西班牙巴伦西亚自治区的428个健康中心和/或初级保健诊所，对35424名受试者进行了横断面多中心研究，该研究于2003年至2004年期间开展，属于预防性活动。当无高血压病史的患者血压高但医务人员将其标记为“正常”时，即确定为诊断惰性；当高血压患者血压值高但治疗未调整时，则确定为治疗惰性。进行双变量和多变量统计分析以识别与惰性相关的患者特征。
32.5%（95%可信区间31.4 - 33.6）的病例存在诊断惰性，37.0%（95%可信区间35.6 - 38.5）的病例存在治疗惰性。在单纯收缩期或舒张期高血压病例中，两者更为常见。在多变量模型中，与诊断惰性相关的因素为2型糖尿病（p = 0.041）、不吸烟（p = 0.004）、既往冠心病（p = 0.001）、血压值（p < 0.001）和体重指数（p = 0.031）；而与治疗惰性相关的因素为2型糖尿病（p = 0.003）、既往冠心病（p = 0.016）或中风（p < 0.001）以及血压值（p < 0.001）。
每三例高血压病例中就有一例存在临床惰性，无论是诊断性还是治疗性的。与临床惰性相关最常见的因素是存在合并症，这需要更低的血压目标以及血压值。
