Characterizing Diagnostic Inertia in Arterial Hypertension With a Gender Perspective in Primary Care

Vicente Pallares-Carratala; Concepcion Carratala-Munuera; Adriana Lopez-Pineda; Jose Antonio Quesada; Vicente Gil-Guillen; Domingo Orozco-Beltran; Jose L Alfonso-Sanchez; Jorge Navarro-Perez; Jose M Martin-Moreno

doi:10.3389/fcvm.2022.874764

Characterizing Diagnostic Inertia in Arterial Hypertension With a Gender Perspective in Primary Care

Front Cardiovasc Med. 2022 Jun 16:9:874764. doi: 10.3389/fcvm.2022.874764. eCollection 2022.

Affiliations

¹ Health Surveillance Unit, Castellon Mutual Insurance Union, Castellón, Spain.
² Department of Medicine, Jaume I University, Castellón, Spain.
³ Clinical Medicine Department, Miguel Hernandez University, Elche, Spain.
⁴ Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain.
⁵ Preventive Medicine Department, General Hospital of Valencia, Valencia, Spain.
⁶ Biomedical Research Institute INCLIVA, Clinic University Hospital of Valencia, University of Valencia, Valencia, Spain.

Abstract

Background and objectives: Substantial evidence shows that diagnostic inertia leads to failure to achieve screening and diagnosis objectives for arterial hypertension (AHT). In addition, different studies suggest that the results may differ between men and women. This study aimed to evaluate the differences in diagnostic inertia in women and men attending public primary care centers, to identify potential gender biases in the clinical management of AHT.

Study design/materials and methods: Cross-sectional descriptive and analytical estimates were obtained nested on an epidemiological ambispective cohort study of patients aged ≥30 years who attended public primary care centers in a Spanish region in the period 2008-2012, belonging to the ESCARVAL-RISK cohort. We applied a consistent operational definition of diagnostic inertia to a registry- reflected population group of 44,221 patients with diagnosed hypertension or meeting the criteria for diagnosis (51.2% women), with a mean age of 63.4 years (62.4 years in men and 64.4 years in women).

Results: Of the total population, 95.5% had a diagnosis of hypertension registered in their electronic health record. Another 1,968 patients met the inclusion criteria for diagnostic inertia of hypertension, representing 4.5% of the total population (5% of men and 3.9% of women). The factors significantly associated with inertia were younger age, normal body mass index, elevated total cholesterol, coexistence of diabetes and dyslipidemia, and treatment with oral antidiabetic drugs. Lower inertia was associated with age over 50 years, higher body mass index, normal total cholesterol, no diabetes or dyslipidemia, and treatment with lipid-lowering, antiplatelet, and anticoagulant drugs. The only gender difference in the association of factors with diagnostic inertia was found in waist circumference.

Conclusion: In the ESCARVAL-RISK study population presenting registered AHT or meeting the functional diagnostic criteria for AHT, diagnostic inertia appears to be greater in men than in women.

Keywords: arterial hypertension; diagnostic inertia; equity; gender; primary care.