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Background— Hypertension may be poorly controlled because patients do not take their medications (poor adherence) or because providers do not increase medication when appropriate (lack of medication intensification, or “clinical inertia”). We examined the prevalence of and relationship between patient adherence and provider treatment intensification.

Methods and Results— We used a retrospective cohort study of hypertensive patients who had filled prescriptions for 1 or more blood pressure (BP) medications at Veterans’ Affairs (VA) healthcare facilities in a Midwestern VA administrative region. Our sample included all patients who received at least 2 outpatient BP medication refills during 2004 and had 1 or more outpatient primary care visits with an elevated systolic BP >140 but <200 mm Hg or diastolic BP >90 mm Hg during 2005 (n=38 327). For each episode of elevated BP during 2005 (68 610 events …