Optimal blood pressure (BP) control is still not being achieved for the majority of patients with hypertension.  Although the topic of patient adherence to health care practitioner recommendations is less than desirable and medication noncompliance adds to the cost of health care, another issue that affects the ability to attain optimal BP control is therapeutic, or clinical, inertia, which is the failure of health care providers to initiate or intensify therapy when indicated.  This paper will discuss therapeutic inertia and other issues that prevent BP goal attainment.