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Hypertension is the most common chronic health condition in the United States and is one of the most important modifiable risk factors for the prevention of cardiovascular events among adults worldwide.1 The results of numerous landmark clinical trials testing many different classes of antihypertensive agents have repeatedly demonstrated that treatment of hypertension dramatically improves clinical outcomes. Despite these data, guideline-adherent achievement of target blood pressure (BP) in individuals treated for hypertension remains frustratingly low.2 Furthermore, observational studies have shown persistent racial and ethnic differences in BP control, most notably a significantly lower proportion of Black and Hispanic patients achieving BP at or below target thresholds.3 Such disparities in care are multifactorial and include population-level, clinician-level, health systems–level, and societal/historical contributing factors related to social determinants of health, race, and ethnicity. Among these many possible factors, one important contributor may be systematic differences in appropriate clinician-initiated intensification of antihypertensive therapy for patients whose BP remains above a specific target, defined as therapeutic inertia. However, there remains a paucity of published data addressing whether therapeutic inertia differs by patient race and ethnicity, which may contribute differences in BP control among Black and Hispanic patients. Elsewhere in JAMA Network Open, Zheutlin et al4 present the results of a secondary analysis of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) in which they aimed to investigate the association of self-identified race and ethnicity with therapeutic inertia, which they defined as no antihypertensive medication intensification by study clinicians at study visits when measured BP was above the target. SPRINT was a highly influential multicenter randomized clinical trial in which adults with hypertension but without diabetes aged 50 years and older with high cardiovascular disease risk were randomized to a standard systolic BP goal of less than 140 mm Hg or an intensive systolic BP goal of less than 120 mm Hg.5 In their study, the authors4 leveraged the high degree of protocol standardization inherent in a clinical trial to robustly assess the association of race and ethnicity with therapeutic inertia, while accounting for important potential confounders, such as sociodemographic characteristics, comorbid depression, and specific antihypertensive medication classes prescribed. Change in the intensity of the antihypertensive medication regimen was quantified using a modified therapeutic intensity score (mTIS) which incorporates the number of antihypertensive medications along with the relative dose of age mediation represented as a proportion of the maximum therapeutic dose. Overall, 8556 participants were included in the final analysis, which was stratified by randomized treatment assignment: 2635 (31%) non-Hispanic Black, 831 (10%) Hispanic, and 5090 (59%) non-Hispanic White participants. The main findings in the study were that after adjustment for potential confounders, therapeutic inertia was similar for Hispanic compared with non-Hispanic White participants and in fact was lower (ie, medications were more likely to be adjusted) for non-Hispanic Black compared with non-Hispanic White participants in the standard treatment arm. The somewhat surprising results of the study by Zheutlin et al4 should not be taken to mean that racial and ethnic differences in therapeutic inertia in hypertension treatment are absent in everyday clinical practice. Care delivered in a clinical trial environment is different in a number of important ways from care delivered outside of a research study. These differences include strict patient inclusion and exclusion criteria, the requirement for detailed informed consent, frequent + Related article