Analysis of Therapeutic Inertia and Race and Ethnicity in Systolic BP

Quick Takes

  • Among participants of SPRINT, rates of therapeutic inertia for blood pressure (BP) control were similar among non-Hispanic White and Hispanic participants but were lower among non-Hispanic Black vs. non-Hispanic White participants.
  • These findings suggest that implementing highly standardized BP measurement and treatment protocols in clinical practice, such as in SPRINT, may reduce racial and ethnic disparities in BP control.

Study Questions:

Does therapeutic inertia in systolic blood pressure (SBP) differ by race and ethnicity?

Methods:

The present analysis was a cross-sectional study using data from SPRINT (Systolic Blood Pressure Intervention Trial). SPRINT was a randomized clinical trial comparing an intensive SBP target of <120 mm Hg to a standard SPB target of <140 mm Hg. SPRINT eligibility criteria included adults aged ≥50 years, at high risk for cardiovascular disease but without diabetes, prior stroke, or heart failure. Participants were enrolled between November 2010–March 2013 and were followed for a median of 3.26 years. Race and ethnicity were collected by self-report; three mutually exclusive groups were created (Hispanic, non-Hispanic Black, or non-Hispanic White). Antihypertensive medication use was assessed with pill bottle inventories at each visit. Blood pressure (BP) was measured using an automated device. For the present analysis, the primary outcome was therapeutic inertia, defined as no antihypertensive medication intensification at each study visit where the SPB was above the target goal.

Results:

A total of 8,556 participants, of which 4,141 were in the standard group (median age, 67.0 years [IQR, 61.0-76.0 years]; 35.4% women) and 4,415 in the intensive group (median age, 67.0 years [IQR, 61.0-76.0 years]; 35.9% women) with at least one eligible study visit were included in the present analysis. The overall prevalence of therapeutic inertia in the standard versus intensive groups was 59.8% (95% CI, 58.9%-60.7%) versus 56.0% (95% CI, 55.2%-56.7%) among non-Hispanic White participants, 56.8% (95% CI, 54.4%-59.2%) versus 54.5% (95% CI, 52.4%-56.6%) among non-Hispanic Black participants, and 59.7% (95% CI, 56.5%-63.0%) versus 51.0% (95% CI, 47.4%-54.5%) among Hispanic participants. The adjusted odds ratios in the standard and intensive groups for therapeutic inertia associated with non-Hispanic Black versus non-Hispanic White participants were 0.85 (95% CI, 0.79-0.92) and 0.94 (95% CI, 0.88-1.01), respectively. The adjusted odds ratios for therapeutic inertia comparing Hispanic versus non-Hispanic White participants were 1.00 (95% CI, 0.90-1.13) and 0.89 (95% CI, 0.79-1.00) in the standard and intensive groups, respectively.

Conclusions:

The investigators concluded that among SPRINT participants above BP target goal, therapeutic inertia prevalence was similar or lower for non-Hispanic Black and Hispanic participants compared with non-Hispanic White participants. These findings suggest that a standardized approach to BP management, as used in SPRINT, may help ensure equitable care, and could reduce the contribution of therapeutic inertia to disparities in hypertension.

Perspective:

Although a secondary analysis, this study using data from SPRINT provides support for the use of standardized treatment protocols for BP measurement among patients of all races and ethnicities. Research on the best methods for implementing and disseminating such protocols is warranted.

Keywords: African Americans, Antihypertensive Agents, Blood Pressure, Ethnic Groups, Healthcare Disparities, Hispanic Americans, Hypertension, Primary Prevention, Race Factors, Therapeutic Equivalency


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