Flatow James S, Byfield Rushelle, Singer Jessica, Chang Melinda J, Schwartz Joseph E, Shimbo Daichi, Kronish Ian M
Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Division of Pediatric Nephrology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
Am J Hypertens. 2025 Apr 15;38(5):280-287. doi: 10.1093/ajh/hpae157.
Clinical inertia is common after office blood pressure (BP) is high. Little is known about clinical inertia after ambulatory BP monitoring (ABPM).
This was an electronic health record-based retrospective cohort study of patients with high office BP (≥140/90 mm Hg) referred for ABPM at a medical center in New York City between 2016 and 2020. Diagnostic inertia was defined as clinicians not newly diagnosing or treating hypertension in patients with high ABPM (i.e., mean awake BP ≥135/85 mm Hg). Therapeutic inertia was defined as clinicians not intensifying treatment for patients with established hypertension after high ABPM. Multilevel modeling was used to assess patient and clinician characteristics associated with inertia.
Among 329 patients without prior hypertension, 144 (44%) had high awake BP. Of these, diagnostic inertia occurred in 45 of 144 (31%). Among 239 patients taking antihypertensive medication, 141 (59%) had high awake BP. Of these, therapeutic inertia occurred in 73 of 141 (52%). In multilevel models, male gender (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.11-7.08), lower awake systolic BP (SBP) (OR 0.73 per 5 mm Hg increase, 95% CI 0.53-1.00), and specialist vs. primary care clinician type (OR 4.57, 95% CI 1.78-11.75) were associated with increased diagnostic inertia. Increasing age (OR 1.16 per 5-year increase, 95% CI 1.00-1.28) and lower awake SBP (OR 0.82 per 5 mm Hg increase, 95% CI 0.66-0.95) were associated with increased therapeutic inertia.
Diagnostic and therapeutic inertia were common after ABPM, particularly when awake SBP was near the threshold.
诊室血压（BP）升高后临床惰性很常见。对于动态血压监测（ABPM）后的临床惰性了解甚少。
这是一项基于电子健康记录的回顾性队列研究，研究对象为2016年至2020年期间在纽约市一家医疗中心因诊室血压高（≥140/90 mmHg）而接受ABPM检查的患者。诊断惰性定义为临床医生未对ABPM血压高的患者（即清醒时平均血压≥135/85 mmHg）新诊断或治疗高血压。治疗惰性定义为临床医生在ABPM血压高后未对已确诊高血压的患者强化治疗。采用多水平模型评估与惰性相关的患者和临床医生特征。
在329例既往无高血压的患者中，144例（44%）清醒时血压高。其中，144例中有45例（31%）出现诊断惰性。在239例服用抗高血压药物的患者中，141例（59%）清醒时血压高。其中，141例中有73例（52%）出现治疗惰性。在多水平模型中，男性（优势比[OR]2.81，95%置信区间[CI]1.11 - 7.08）、较低的清醒收缩压（SBP）（每升高5 mmHg，OR 0.73，95% CI 0.53 - 1.00）以及专科医生与初级保健临床医生类型（OR 4.57，95% CI 1.78 - 11.75）与诊断惰性增加相关。年龄增加（每增加5岁，OR 1.16，95% CI 1.00 - 1.28）和较低的清醒SBP（每升高5 mmHg，OR 0.82，95% CI 0.66 - 0.95）与治疗惰性增加相关。
ABPM后诊断和治疗惰性很常见，尤其是当清醒SBP接近阈值时。
