O41 Clinical Inertia in Patients With Resistant Hypertension Controlled by Ambulatory Blood Pressure Measurements

Background and objective: Uncontrolled hypertension, especially among high cardiovascular risk patients like those with resistant hypertension (r-HTN), remains a significant public health concern. Clinical inertia, the failure to initiate or intensify therapy, is a major contributor to uncontrolled hypertension, including in r-HTN patients. We aimed to assess the prevalence of clinical inertia and its associated characteristics in r-HTN patients. Methods: A retrospective analysis of consecutive Ambulatory Blood Pressure Measurements (ABPM) in patients between August 2016 and August 2023 in a Cordoba, Argentina tertiary center was performed. r-HTN was defined by ABPM when optimal or best-tolerated doses of three drugs failed to control blood pressure (BP) or the patient received four or more drugs regardless of BP control. Therapeutic inertia was diagnosed when uncontrolled BP persisted without pharmacological changes in the subsequent visit to the ABPM. Failure to exclude secondary causes of hypertension constituted diagnostic inertia. Results: 168 patients were included; mean age 66 years (Range 33-87), 55% females. r-HTN prevalence was 31.5% (53/168). Overall uncontrolled BP was 61.9% (104/168), with r-HTN patients exhibiting higher rates (75% vs 55.7%; p=0.014) of uncontrolled BP. Therapeutic inertia was 28.6% (48/168), being more frequent in r-HTN patients (41.5% vs 22.6%; p=0.012). Patients with therapeutic inertia had a greater number of comorbidities (1.2 ± 1.0 vs. 0.7 ± 1.0; p=0.003), diabetes (52% vs. 33%; p=0.024), more anti-hypertensive drugs (3.4 ± 0.6 vs. 3.2 ± 0.7; p=0.039), and higher BP values during ABPM. In a multiple regression model, only SBP24 independently predicted therapeutic inertia (p<0.01). Diagnostic inertia was 86.3% (145/168), lower in r-HTN patients (75.5% vs 91.3%; p=0.006). Patients with diagnostic inertia had lower BMI (30.0 ± 4.7 vs 31.2 ± 9.8; p=0.043), coronary artery disease (10% vs 26%; p=0.034), and fewer anti-HTN drugs (3.2 ± 0.6 vs 3.7 ± 0.9; p=0.002). Conclusion: Clinical inertia in resistant hypertension patients is highly prevalent, emphasizing the necessity of improving inertia to enhance blood pressure control and patient outcomes. Table 2. - Clinical variables associated with the diagnosis of therapeutical inertia.