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Am J Med Sci. 2009 Nov;338(5):368-72. doi: 10.1097/MAJ.0b013e3181b473dc.

Self-reported influences of hopelessness, health literacy, lifestyle action, and patient inertia on blood pressure control in a hypertensive emergency department population.

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Consortium for Southeastern Hypertension Control, Winston Salem, North Carolina 27113-5097, USA.



In response to almost universally recorded poor blood pressure (BP) control rates, we developed a novel health paradigm model to examine the mindset behind BP control barriers. This approach, termed patient inertia (PtInert), is defined as an individual's failure to take responsibility for health conditions and proactive change.


PtInert was evaluated through a survey instrument conducted in 85 subjects with a prior history of hypertension seen in an emergency department. The survey tool encompassed the Wide Range Achievement Test 4, the brief symptom inventory, and a PtInert questionnaire.


Fifty percent of patients reported slight psychological distress (psychosomatic > anxiety > depression), with 61% possessing hopelessness surrounding complications from high BP no matter their actions. An unanticipated finding was that patients who had a low reading proficiency (83.1 + 16.4 Wide Range Achievement Test 4 standard score) self-reported high levels of hypertension health literacy. Less than half of patients transferred this health literacy into lifestyle changes in diet, exercise, and medication adherence. Although patients felt that they could control their BP and frequently thought about better BP control, 55% of the subjects had uncontrolled hypertension (>140/90 mm Hg).


Hypertensive patients visiting our emergency department perceive themselves to have adequate hypertension health-related literacy that was not transferred into hypertension health protective behavioral practices. Psychological distress and a sense of hopelessness surrounding BP control contribute to the lack of protective behavioral health practices. Further evaluations of PtInert methods to promote successful proactive change and adherence warrant further study.

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