Physician-related inertia attitudes were independently associated with high-level inappropriate clinical inertia in hypertension management (OR 1.95; 95% CI 1.40-2.71; p<0.001).
Cross-Sectional (n=868)
Therapeutic inertia is highly prevalent among South Korean physicians managing hypertension, driven largely by physician-related attitudes, advanced patient age, and modest BP elevations.
Odds Ratio: 1.95 (95% CI 1.4–2.71)
p-value: p=<0.001
Objective: Therapeutic inertia (TI)—the failure to intensify treatment despite unachieved blood pressure (BP) targets—is a major barrier to hypertension control. This study aimed to quantify TI using diverse clinical scenarios and to identify physician-level determinants in South Korea. Design and method: An online survey was conducted among 912 physicians; data from 868 respondents were analyzed. Participants evaluated eight clinical scenarios varying by patient age (=75 years), BP target (=10 mmHg). Decisions not to intensify therapy (non-intensification, NI) were adjudicated for clinical appropriateness. Appropriate Clinical Response (ACR) was defined as either treatment intensification when indicated or a justified, rational delay in NI cases. Decisions that did not meet ACR criteria were classified as inappropriate clinical inertia (ICI). TI attitudes were assessed using a structured Likert-scale survey. Results: Only 13.5% (n=117) of physicians intensified therapy in all scenarios. After adjudication, 20.5% (n=178) demonstrated ACR across all scenarios, whereas 79.5% (n=690) exhibited at least one instance of ICI. On average, physicians chose NI in 4.0 out of 8 scenarios. The mean ICI frequency was 3.0 out of 8 scenarios, indicating that approximately three-quarters of NI decisions were clinically inappropriate. NI was strongly correlated with ICI (r = 0.76, p 10 mmHg (69% vs. 31%, p =75 years) than in younger patients (index 0.43 vs. 0.33; p =30 years of practice showed a higher prevalence of high-level ICI (5–8 scenarios) than those with 5–10 years of experience (38.7% vs 18.2%, p=0.001), which remained significant after Bonferroni correction for multiple comparisons (adjusted alpha = 0.005). Multivariate logistic regression revealed that physician-related inertia attitudes were independently associated with high-level ICI (OR 1.95, 95% CI 1.40–2.71; p <0.001), whereas patient-, system-, and uncertainty-related attitudes were not. Conclusions: Therapeutic inertia is prevalent among South Korean clinicians. Most NI decisions reflect inappropriate inertia, not justified delay. Advanced age, modest BP elevation, and long experience drive this
Rhee et al. (2026) conducted a cross-sectional in Hypertension (n=868). Physician-related inertia attitudes was evaluated on High-level inappropriate clinical inertia (ICI) (OR 1.95, 95% CI 1.40-2.71, p=<0.001). Physician-related inertia attitudes were independently associated with high-level inappropriate clinical inertia in hypertension management (OR 1.95; 95% CI 1.40-2.71; p<0.001).