Analysing the concept of diagnostic inertia in hypertension: a cross‐sectional study

Summary Aims The aim of this study was to quantify diagnostic inertia ( DI ) when the physician fails to diagnose hypertension and determine its associated factors. Methods This cross‐sectional, observational study involved all patients without a diagnosis of hypertension who had their blood pressure ( BP ) measured at least three times during the second half of 2010 ( N  = 48,605). Patients with altered mean BP figures (≥ 140/90 mmHg) were considered to experience DI . Secondary variables: gender, atrial fibrillation, diabetes mellitus, dyslipidemia, cardiovascular disease, age and the physician having attended a cardiovascular training course ( ESCARVAL ). Associated factors were assessed by multivariate logistic regression analysis. Results Diagnostic inertia was present in 6450 patients (13.3%, 95% CI : 13.0–13.6%). Factors significantly associated with DI were: male gender ( OR  = 1.46, 95% CI : 1.37–1.55, p < 0.001), atrial fibrillation ( OR  = 0.73, 95% CI : 0.58–0.92, p = 0.007), the ESCARVAL cardiovascular course ( OR  = 0.88, 95% CI : 0.81–0.96, p = 0.005), diabetes mellitus ( OR  = 0.93, 95% CI : 0.87–0.99, p = 0.016), cardiovascular disease ( OR  = 0.77, 95% CI : 0.67–0.88, p < 0.001) and older age (years) (18–44→ OR  = 1; 45–59→ OR  = 12.45, 95% CI : 11.11–13.94; 60–74→ OR  = 18.11, 95% CI : 16.30–20.12; ≥ 75→ OR  = 20.43, 95% CI : 18.34–22.75; p < 0.001). The multivariate model had an area under the ROC curve of 0.81 (95% CI : 0.80–0.81, p < 0.001). Conclusions This study will help clinical researchers differentiate between the two forms of DI (interpretation of a positive screening test and interpretation of positive diagnostic criteria). The results found here in patients with hypertension suggest that this problem is prevalent, and that a set of associated factors can explain the outcome well ( AUC >0.80).