Strategies to reduce clinical inertia in hypertensive kidney transplant recipients

Background. Many kidney transplant recipients have hypertension. Elevated systolic blood pressures are associated with lower patient and kidney allograft survival. Methods. This retrospective analysis examined the prevalence of clinical inertia (failure to initiate or increase therapy) in the treatment of hypertension before and after the introduction of an automated device (BpTRU) in the kidney transplant clinic. Results. Historically only 36% (49/134) of patients were prescribed a change in therapy despite a systolic blood pressure ≥ 130 mmHg. After the introduction of BpTRU, 56% (62/110) of the patients had a change in therapy. In a multivariate logistic regression analysis of the entire cohort (n = 244) therapeutic changes were associated with higher blood pressures (OR 1.08 per mmHg, 95% CI 1.04-1.12) and use of the BpTRU (OR 2.12, 95% CI 1.72-3.83). In addition patients on more medications were also more likely to have a change in therapy. Conclusion. Blood pressure measurement with automated devices may help reduce clinical inertia in the kidney transplant clinic.