Clinical inertia in the management of hypertension: a national survey of French general practitioners

BACKGROUND: Hypertension remains a leading modifiable cardiovascular risk factor, yet blood pressure (BP) control in France and across Europe remains suboptimal. Although poor patient adherence is frequently cited, physician-related factors, particularly therapeutic inertia, may also contribute substantially. In this national survey, we assessed whether French general practitioners (GPs) have updated their perceptions of BP targets and treatment thresholds in the context of evolving European recommendations. METHODS: Between May 2023 and December 2024, a structured questionnaire was administered by telephone to a representative sample of 503 French GPs. The findings were compared with those of a similar survey conducted in 2010 (SHARE study) in order to evaluate temporal changes in physicians' perceptions and clinical attitudes toward hypertension management. RESULTS: Most respondents perceived current BP targets as overly stringent and estimated that most of their patients were adequately controlled. The reported BP thresholds for satisfaction (136/85 mmHg), concern (148/93 mmHg), and therapeutic intervention (166/101 mmHg) were strikingly similar to those observed in 2010, suggesting limited evolution in clinical perceptions despite increasingly stringent guideline recommendations. Younger physicians more frequently prioritized home BP monitoring and adopted lower treatment thresholds, whereas older GPs more commonly preferred office-based measurements and tolerated higher BP levels. CONCLUSIONS: The limited evolution in GPs' perceptions over time suggests persistent therapeutic inertia in hypertension management. Targeted strategies to improve adherence to guideline-recommended BP control in this setting appear warranted.