We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Analysis of Therapeutic Inertia and Race and Ethnicity in the Systolic Blood Pressure Intervention Trial: A Secondary Analysis of a Randomized Clinical Trial.
- Authors
Zheutlin, Alexander R.; Mondesir, Favel L.; Derington, Catherine G.; King, Jordan B.; Zhang, Chong; Cohen, Jordana B.; Berlowitz, Dan R.; Anstey, D. Edmund; Cushman, William C.; Greene, Tom H.; Ogedegbe, Olugbenga; Bress, Adam P.
- Abstract
Key Points: Question: Is the prevalence of therapeutic inertia for the treatment of hypertension similar across racial and ethnic participant groups? Findings: In this secondary cross-sectional analysis of 8556 participants in the Systolic Blood Pressure Intervention Trial , among participants with blood pressure above their randomized treatment goal, therapeutic inertia occurred at similar frequencies among non-Hispanic White and Hispanic participants but was lower among non-Hispanic Black vs non-Hispanic White participants. Meaning: These findings suggest that implementing highly standardized blood pressure measurement and treatment protocols in clinical practice, such as those imposed in clinical trial settings, may reduce racial and ethnic disparities in blood pressure control. This cross-sectional study examines whether racial and ethnic differences were present for therapeutic inertia among participants in the Systolic Blood Pressure Intervention Trial. Importance: Therapeutic inertia may contribute to racial and ethnic differences in blood pressure (BP) control. Objective: To determine the association between race and ethnicity and therapeutic inertia in the Systolic Blood Pressure Intervention Trial (SPRINT). Design, Setting, and Participants: This cross-sectional study was a secondary analysis of data from SPRINT, a randomized clinical trial comparing intensive (<120 mm Hg) vs standard (<140 mm Hg) systolic BP treatment goals. Participants were enrolled between November 8, 2010, and March 15, 2013, with a median follow-up 3.26 years. Participants included adults aged 50 years or older at high risk for cardiovascular disease but without diabetes, previous stroke, or heart failure. The present analysis was restricted to participant visits with measured BP above the target goal. Analyses for the present study were performed in from October 2020 through March 2021. Exposures: Self-reported race and ethnicity, mutually exclusively categorized into groups of Hispanic, non-Hispanic Black, or non-Hispanic White participants. Main Outcomes and Measures: Therapeutic inertia, defined as no antihypertensive medication intensification at each study visit where the BP was above target goal. The association between self-reported race and ethnicity and therapeutic inertia was estimated using generalized estimating equations and stratified by treatment group. Antihypertensive medication use was assessed with pill bottle inventories at each visit. Blood pressure was measured using an automated device. Results: A total of 8556 participants, including 4141 in the standard group (22 844 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1467 women [35.4%]) and 4415 in the intensive group (35 453 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1584 women [35.9%]) with at least 1 eligible study visit were included in the present analysis. Among non-Hispanic White, non-Hispanic Black, and Hispanic participants, the overall prevalence of therapeutic inertia in the standard vs intensive groups was 59.8% (95% CI, 58.9%-60.7%) vs 56.0% (95% CI, 55.2%-56.7%), 56.8% (95% CI, 54.4%-59.2%) vs 54.5% (95% CI, 52.4%-56.6%), and 59.7% (95% CI, 56.5%-63.0%) vs 51.0% (95% CI, 47.4%-54.5%), respectively. The adjusted odds ratios in the standard and intensive groups for therapeutic inertia associated with non-Hispanic Black vs 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 vs 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 and Relevance: Among SPRINT participants above BP target goal, this cross-sectional study found that 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. Trial Registration: ClinicalTrials.gov identifier: NCT01206062
- Subjects
HYPERTENSION; ANTIHYPERTENSIVE agents; BLOOD pressure; CORRUPTION; KRUSKAL-Wallis Test; DIURETICS; ADRENERGIC alpha blockers; CONFIDENCE intervals; CROSS-sectional method; SELF-evaluation; AGE distribution; CALCIUM antagonists; RACE; ORGANIZATIONAL behavior; T-test (Statistics); STATISTICAL hypothesis testing; MENTAL depression; ASPIRIN; RESEARCH funding; ETHNOLOGY; ODDS ratio; MEDICAID; BODY mass index; ANGIOTENSIN receptors; SECONDARY analysis; MEDICARE; ANGIOTENSIN converting enzyme
- Publication
JAMA Network Open, 2022, Vol 5, Issue 1, pe2143001
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.43001