Clinical inertia affects more than half of high-risk primary care patients with uncontrolled cardiovascular risk factors, significantly increasing the risk of remaining uncontrolled and resulting in meaningfully smaller reductions in cholesterol levels at 90-day follow-up.
Key Findings
Results
Clinical inertia was prevalent in over half of high-risk primary care patients with at least one uncontrolled cardiovascular risk factor.
54.3% of participants (n/N = 386/711) exhibited clinical inertia in at least one condition.
The study included 711 participants with at least one uncontrolled cardiovascular risk factor (hypertension, diabetes, or dyslipidaemia) at baseline.
The study was conducted across nine Spanish regions in 2024–2025 as part of the multicentre, prospective, quasi-experimental OPM study.
Clinical inertia was operationalised among therapeutically adherent patients as the absence of documented pharmacological treatment initiation, dose escalation, or appropriate combination therapy when a risk factor remained uncontrolled.
Results
Clinical inertia prevalence varied by cardiovascular risk factor, with hypertension showing the highest rate.
Clinical inertia was observed in 49.3% (n/N = 208/422) of patients with uncontrolled hypertension.
Clinical inertia was observed in 31.1% (n/N = 73/235) of patients with uncontrolled diabetes.
Clinical inertia was observed in 38.2% (n/N = 217/568) of patients with uncontrolled dyslipidaemia.
Hypertension had both the highest absolute prevalence of clinical inertia and the largest proportion of affected patients among those with the condition uncontrolled.
Results
Clinical inertia significantly increased the risk of remaining uncontrolled across any cardiovascular risk condition.
Relative risk = 1.13 (95% CI = 1.03, 1.24; P = 0.007).
Absolute risk difference = 9.3% (95% CI = 2.4, 16.2).
Number needed to harm ≈ 11.
The increased risk of remaining uncontrolled was statistically significant when all conditions were considered together, but not for individual conditions separately.
Results
Patients with clinical inertia showed significantly smaller reductions in total cholesterol and LDL cholesterol at 90-day follow-up compared to patients who received treatment intensification.
Between-group difference in total cholesterol change = 19.3 mg/dL (95% CI = 12.4, 26.3; P < 0.001).
Between-group difference in LDL cholesterol change = 15.5 mg/dL (95% CI = 8.9, 22.0; P < 0.001).
Follow-up period was 90 days.
No significant between-group differences were found for glycaemic parameters, HDL cholesterol, or triglycerides.
Results
Both groups showed significant within-group reductions in blood pressure, but the magnitude of change did not differ significantly between patients with and without clinical inertia.
Both patients with and without clinical inertia showed significant within-group reductions in systolic and diastolic blood pressure (P < 0.001 for each group).
Between-group interaction P > 0.05 for both systolic blood pressure and diastolic blood pressure.
This finding suggests factors other than treatment intensification, such as lifestyle changes or regression to the mean, may have contributed to blood pressure reductions in both groups.
Results
A small but statistically significant difference in BMI reduction was observed between patients with and without clinical inertia.
Between-group difference in BMI change = 0.25 kg/m² (95% CI = 0.02, 0.49; P = 0.036).
Patients without clinical inertia (i.e., those who received treatment intensification) had greater BMI reductions.
The clinical magnitude of this BMI difference was described as small.
Results
No statistically significant associations were found between clinical inertia and patient-level demographic or clinical characteristics including age, sex, cardiovascular risk category, or excess weight.
Multivariable logistic regression was used to identify factors associated with clinical inertia.
Age, sex, CVR category, and excess weight were all examined and none were significantly associated with clinical inertia.
The authors noted this finding is 'consistent with, but not proof of, provider- and system-level influences described in prior literature.'
The absence of patient-level predictors suggests clinical inertia may be driven more by provider or system factors than by patient characteristics.
What This Means
This research suggests that a phenomenon called 'clinical inertia' — when doctors do not start or increase treatment even when a patient's condition remains uncontrolled — is very common in primary care. In a study of 711 Spanish patients who had at least one poorly controlled cardiovascular risk factor (high blood pressure, diabetes, or high cholesterol), more than half (54.3%) experienced clinical inertia for at least one of their conditions. Hypertension had the highest rate, with nearly half of patients not receiving needed treatment adjustments. Patients with clinical inertia were about 13% more likely to remain uncontrolled overall, and on average needed to treat roughly 11 patients with inertia to see one additional case of persistent uncontrolled risk compared to those receiving proper intensification.
The consequences of clinical inertia were most clearly seen in cholesterol management. Patients whose treatment was appropriately intensified saw their total cholesterol drop by nearly 19 mg/dL more, and their LDL ('bad') cholesterol drop by over 15 mg/dL more, compared to those who experienced clinical inertia over the 90-day study period. Interestingly, blood pressure improved in both groups by similar amounts, which may reflect lifestyle changes or other factors beyond medication adjustments. There were no meaningful differences in blood sugar control between the groups.
This research also suggests that clinical inertia does not appear to be explained by patient characteristics such as age, sex, weight, or overall cardiovascular risk level. This points toward provider behavior and healthcare system factors as more likely drivers of the problem. These findings highlight a significant gap between clinical guidelines and real-world practice in primary care, and suggest that improving systems and clinical culture around treatment decision-making could meaningfully improve cardiovascular risk management for a large share of patients.
Alemán J, Lezcano P, Pardo D, Guerra L, Sabaris R, Portillo G, et al.. (2026). Clinical inertia in cardiovascular risk management: prevalence, associated factors, and impact on outcomes of the OPM study.. Journal of global health. https://doi.org/10.7189/jogh.16.04256