Pretorean T, Claisse G, Delsart P, Caudrelier T, Devos P, Mounier-Vehier C
Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
Service de médecine vasculaire et d'hypertension artérielle, pôle cardio-vasculaire-pulmonaire, hôpital cardiologique, CHRU de Lille, 59037 Lille cedex, France.
J Mal Vasc. 2014 Feb;39(1):4-13. doi: 10.1016/j.jmv.2013.09.001. Epub 2013 Oct 8.
Therapeutic inertia (TI) is a recent concept still unknown by many physicians. In chronic diseases such as hypertension, it is defined as the tendency of physicians not to increase or change antihypertensive medications when the target blood pressure is not reached. Acting on TI could improve blood pressure control in France.
This was a single-center prospective pilot study conducted by hypertension specialist physicians at the University Cardio-Vascular Center in Lille (France). It was conducted between March and June 2011. Data was collected from 161 hypertensive patients (mean age: 61.64±11.18 years; 98 (60.9%) male; 75 secondary prevention patients). Each physician completed a questionnaire on therapeutic inertia. TI was defined as a consultation in which treatment change was indicated (systolic blood pressure [BP]≥140 and/or diastolic BP≥90mmHg in all patients), but did not occur, with absence of an adapted justification of this choice. We considered as an adapted justification: a white coat effect demonstrated by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring; scheduled reassessment of the BP by ABPM; recent change in antihypertensive treatment (less than 4 weeks); hospitalization needed for complete evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage in patients with grade 1 or 2 hypertension. Our study aimed to evaluate rates of TI, to identify factors associated with TI, and to test the TI questionnaire.
Therapeutic inertia as defined in this study occurred in 11 consultations (8.3%) of the 133 hypertensive patients having uncontrolled BP above or equal to 140 and/or 90mmHg. Significant factors associated with TI were older age (Z=2.35, P<0.05) and sleep apnea syndrome (χ(2)=8.33, P<0.05). The absence of ambulatory blood pressure monitoring before the consultation (χ(2)=4.28, 0.1>P>0.05) and the number of consultations (Z=1.92, 0.1>P>0.05) exhibited a significant trend to be associated with TI.
Although the rate of TI was low in our study conducted in a specialized center, a well-accepted definition of therapeutic inertia would be useful for further study. The feasibility of using the questionnaire tested with this study shows that this measurement tool could help physicians become more aware of TI, both in the hospital and primary care setting. Further multicenter studies are needed for validation.
治疗惰性（TI）是一个近期提出的概念，许多医生对此仍不了解。在高血压等慢性病中，它被定义为当未达到目标血压时医生不增加或改变抗高血压药物的倾向。针对治疗惰性采取行动可能会改善法国的血压控制情况。
这是一项由法国里尔大学心血管中心的高血压专科医生进行的单中心前瞻性试点研究。研究于2011年3月至6月进行。收集了161例高血压患者的数据（平均年龄：61.64±11.18岁；98例（60.9%）为男性；75例为二级预防患者）。每位医生完成了一份关于治疗惰性的问卷。治疗惰性被定义为在一次会诊中，虽表明需要改变治疗（所有患者收缩压[BP]≥140和/或舒张压BP≥90mmHg），但实际未发生改变，且对此选择缺乏适当的理由。我们认为适当的理由包括：动态血压监测（ABPM）或家庭血压监测显示的白大衣效应；通过ABPM定期重新评估血压；近期抗高血压治疗的改变（少于4周）；因需全面评估高血压的继发原因而住院，以及对1级或2级高血压患者潜在靶器官损害进行更详细的评估。我们的研究旨在评估治疗惰性的发生率，确定与治疗惰性相关的因素，并测试治疗惰性问卷。
在133例血压未得到控制（收缩压≥140和/或舒张压≥90mmHg）的高血压患者的11次会诊（8.3%）中出现了本研究定义的治疗惰性。与治疗惰性相关的显著因素为年龄较大（Z=2.35，P<0.05）和睡眠呼吸暂停综合征（χ(2)=8.33，P<0.05）。会诊前未进行动态血压监测（χ(2)=4.28，0.1>P>0.05）以及会诊次数（Z=1.92，0.1>P>0.05）呈现出与治疗惰性相关的显著趋势。
尽管在我们这个专科中心进行的研究中治疗惰性发生率较低，但一个被广泛接受的治疗惰性定义对于进一步研究将是有用的。使用本研究测试的问卷的可行性表明，这种测量工具可以帮助医生在医院和初级保健环境中更加了解治疗惰性。需要进一步开展多中心研究进行验证。
