CLINICAL INERTIA IN PRESCRIBING LIPID-LOWERING THERAPY IN HYPERTENSIVE AND NORMOTENSIVE SUBJECTS IN CROATIA – EHUH-2 STUDY

Objective: This study aimed to analyze clinical inertia in prescribing lipid-lowering therapy (LLT) in hypertensive (HT) and normotensive (NT) adult subjects. Design and method: The EHUH-2 study is a cross-sectional study conducted in a representative adult population in Croatia. Out of 2021 total subjects, 1327 were included in this analysis. Participants were stratified into the following groups: Controlled HT patients (CHT) (N=56), uncontrolled HT patients (UCT) (N=105), not-treated HT patients (NHT) (N=782), normotensive patients (NT) (N=384). Clinical inertia for LLT was defined as: high (when patients have not been prescribed any lipid-lowering therapy, when a high-potency statin is prescribed at a low dose, or when a low-potency statin is prescribed at a low or medium dose), moderate (when a high-potency statin is prescribed at a medium dose or when a low-potency statin is prescribed at a high dose), low (patients on a high-potency statin at maximum dose +/- ezetimibe). According to recent guidelines, the cut-off values of LDL were determined based on co-morbidity and global risk. Results: Data on the prevalence, treatment, control, and clinical inertia of hyperlipidemia are shown in Table/Picture 1. LDL above the cut-off value was found in 71.6% and 61.7% of HT and NT subjects, respectively. Only 22.1% and 6.5% of HT and NT participants were treated with LLT, respectively. LDL below the cut-off value was found in 35.2% and 47.6% of HT and NT subjects, respectively. None of the participants were treated with maximal/optimal statin doses, and ezetimibe was added in less than 5%. Clinical inertia was high in more than 80% of subjects.Conclusions: The results highlight notable clinical inertia in prescribing lipid-lowering therapy across all groups analyzed, especially among uncontrolled hypertensive patients. Despite the high prevalence of elevated LDL cholesterol, treatment and control rates remain suboptimal. Additional interventions are necessary to reduce clinical inertia and improve the management of dyslipidemia, particularly in uncontrolled and untreated hypertensive populations.