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Research Letter |

Depression and Clinical Inertia in Patients With Uncontrolled Hypertension

Nathalie Moise, MD1; Karina W. Davidson, PhD1,2; William Chaplin, PhD1,3; Steven Shea, MD, MS1,4; Ian Kronish, MD, MPH1
[+] Author Affiliations
1Center for Behavioral and Cardiovascular Health, Division of General Medicine, Columbia University Medical Center, New York, New York
2Department of Psychiatry, Columbia University Medical Center, New York, New York
3Department of Psychology, St John’s University, Queens, New York
4Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, New York
JAMA Intern Med. 2014;174(5):818-819. doi:10.1001/jamainternmed.2014.115.
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Depression is a known risk factor for poor prognosis among patients with cardiovascular disease.1 Numerous biological and behavioral mechanisms have been proposed.2 However, few studies have investigated the association between depression and “clinical inertia,” or lack of treatment intensification in individuals not at evidence-based goals for care.3 To address this gap, we assessed whether a diagnosis of depression is associated with clinical inertia in patients with uncontrolled hypertension.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Clinical inertia and the role of continuity of care
Posted on March 19, 2014
Carol Sinnott
Department of General Practice, University College Cork
Conflict of Interest: None Declared
Patients in this study had, on average, 5.3 medical issues addressed in a consultation. Those who had depression were less likely to have their antihypertensive treatment intensified in the index consultation under study. What would be interesting is to follow these patients with time and see if, in the course of managing the competing demands of 5.3 other issues in the consultation, the physicians involved made provisions to deal with management of hypertension in an imminent consultation. Multimorbid patients such as these may be better served by a longtitudinal relationship with one primary care physician who will make appropriate adjustments over time, rather than referral to specialists or additional investigations that may to only add to a patients burden without any benefit in blood pressure control, or indeed health.
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