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Sleep Apnea and Blood Pressure Control Among Blacks
Study Questions:
Is sleep apnea associated with uncontrolled blood pressure (BP) and resistant hypertension (HTN) in blacks?
Methods:
Data from the Jackson Heart Sleep Study were used for the present analysis. Participants who completed an in-home sleep apnea study between 2012 and 2016 and had BP anthropometric measurements at that time were included in the present study. Moderate or severe obstructive sleep apnea (OSA) was defined as a respiratory event index ≥15, and nocturnal hypoxemia was quantified as percent sleep time with <90% oxyhemoglobin saturation. Prevalent HTN was defined as either a systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) >80 mm Hg, use of antihypertensive medication, or self-report of a diagnosis of HTN. Controlled BP was defined as SBP <130 mm Hg and DBP <80 mm Hg; and uncontrolled BP as SBP ≥130 mm Hg or DBP ≥80 mm Hg with use of 1-2 classes of antihypertensive medications. Resistant BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg with the use of ≥3 classes of antihypertensive medication (including a diuretic) or use of ≥4 classes of antihypertensive medication regardless of BP level. The primary outcomes of interest were uncontrolled BP and/or resistant HTN.
Results:
Of the 913 participants included, 664 had HTN (mean age 64 years, 69.1% female). Among participants with HTN, 58.6% were obese and 51.3% were college educated. Approximately 25% of the cohort had OSA, of which most were untreated (94%). Overall, 48% of participants had uncontrolled HTN and 14% had resistant HTN. After adjustment for confounders, participants with moderate or severe OSA had a 2.0 times higher odds of resistant HTN (95% confidence interval [CI], 1.14–3.67). Each standard deviation higher than <90% oxyhemoglobin saturation was associated with an adjusted odds ratio for resistant HTN of 1.25 (95% CI, 1.01–1.55). OSA and <90% oxyhemoglobin saturation were not associated with uncontrolled BP.
Conclusions:
The authors concluded that untreated moderate or severe OSA is associated with increased odds of resistant HTN. These results suggest that untreated OSA may contribute to inadequate BP control in blacks.
Perspective:
These data suggest that OSA is common among blacks and is associated with poorly controlled HTN. Providers are recommended to diagnose and treat OSA if suspected, particularly among patients with poorly controlled BP.
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension, Sleep Apnea
Keywords: Antihypertensive Agents, Blood Pressure, Diuretics, Hypertension, Hypoxia, Brain, Obesity, Oxyhemoglobins, Polysomnography, Primary Prevention, Sleep Apnea, Obstructive, Sleep Apnea Syndromes
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