The Hypertension Disconnect: Investigating Therapeutic Inertia and Patient Outcomes in Primary Care

Rachel Lim¹, Jie Tan², Suresh Menon³, Daniel Chua⁴

Abstract

Background: Despite widely available treatment guidelines, blood pressure control remains suboptimal in many hypertensive patients. Therapeutic inertia—failure to intensify treatment when needed—may be a hidden driver. This study examined the prevalence, predictors, and consequences of therapeutic inertia in the management of hypertension across urban clinics.
Methods: A retrospective cohort study was conducted using electronic health records of 1,024 adult hypertensive patients from five primary care centres in Singapore between 2021 and 2024. Inclusion required at least three consecutive visits with elevated systolic BP ≥140 mmHg. Therapeutic inertia was defined as no change in medication despite persistent elevation of the condition. Patient demographics, comorbidities, physician characteristics, and visit intervals were analysed. Primary outcomes included the incidence of therapeutic inertia, follow-up blood pressure levels, and cardiovascular events over a 12-month period.
Results: Therapeutic inertia was observed in 42.6% of eligible cases. Patients experiencing inertia were more likely to be older (mean age 64.8 vs. 58.3 years, p < 0.001), have diabetes (56.7% vs. 39.2%, p = 0.004), and be managed by physicians with ≥10 years of experience (OR = 1.84, 95% CI: 1.22–2.76, p = 0.003). Those with therapeutic inertia had lower rates of blood pressure control at 12 months (38.9% vs. 67.4%, p < 0.001) and a higher incidence of cardiovascular events (9.1% vs. 3.2%, p = 0.008).
Conclusion: Therapeutic inertia remains prevalent in primary care and is associated with poorer blood pressure control and increased cardiovascular risk. Interventions targeting clinical decision-making, patient engagement, and provider awareness are critical to improving long-term outcomes in hypertensive populations.