Association between sleep apnea and blood pressure control in African Americans
African Americans have a high prevalence of both hypertension and uncontrolled blood pressure (BP), each of which may be partially explained by untreated sleep apnea.1
In fact, African Americans have the highest prevalence of hypertension of any race/ethnic group in the United States and have 90% higher odds of uncontrolled BP compared with non-Hispanic whites.2,3 The reasons for these disparities are not widely understood.
However, in the Multi-Ethnic Study of Atherosclerosis (MESA), 84% of African American participants who had sleep-disordered breathing did not report a physician diagnosis of sleep-disordered breathing, suggesting a high prevalence of untreated obstructive sleep apnea (OSA) in this population.4
The Jackson Heart Study
The Jackson Heart Study (JHS) is a longitudinal study of 5306 African American adults, aged 21 to 95, enrolled from three counties in Jackson, Mississippi between 2000 and 2004. JHS was designed to study the cause of cardiovascular disease among African Americans. Three core examinations have been conducted to date. The current analyses use data from the JHSS, an ancillary study conducted between December 2012 and May 2016 after the third JHS examination.5
This current research included participants with hypertension (high BP, use of antihypertensive medication or self-reported diagnosis; N=773). Sleep apnea was assessed with a home sleep apnea device.6,7 The analysis was further restricted to exclude those without a valid home sleep apnea test (N=51), or those with missing data on hypertension, measured BP, or number of antihypertensive medications and diuretic use (N=58). The final sample consisted of 664 participants.
What did the study find?
The study shows that OSA, defined by an elevated respiratory event index or overnight hypoxemia, is associated with resistant hypertension among African Americans. 1
Further, moderate or severe OSA was associated with resistant hypertension but not uncontrolled BP (high blood pressure while taking ≥3 medications to control their blood pressure), suggesting that OSA is associated with more severe forms of hypertension.1
What are the clinical implications?
This study suggests that untreated OSA may contribute to hard-to-control blood pressure in African Americans.1
The results of the study support hypertension guidelines which encourage OSA screening in patients with hypertension, particularly among those who require the use of ≥4 medications to control their blood pressure.1
Johnson DA, Thomas SJ, Abdallah M, Guo N, Yano Y, Rueschman M, Tanner RM, Mittleman MA, Calhoun DA, Wilson JG, Muntner P, Redline S. Association between sleep apnea and blood pressure control among blacks. Jackson Heart Sleep Study. Originally published10 Dec 2018https://doi.org/10.1161/CIRCULATIONAHA.118.036675Circulation. 2019;139:1275–1284
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Redmond N, Baer HJ, Hicks LS. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey.Hypertension. 2011; 57:383–389. doi: 10.1161/HYPERTENSIONAHA.110.161950
Chen X, Wang R, Zee P, Lutsey PL, Javaheri S, Alcántara C, Jackson CL, Williams MA, Redline S. Racial/ethnic differences in sleep disturbances: the Multi-Ethnic Study of Atherosclerosis (MESA).Sleep. 2015; 38:877–888. doi: 10.5665/sleep.4732
Fuqua SR, Wyatt SB, Andrew ME, Sarpong DF, Henderson FR, Cunningham MF, Taylor HARecruiting African-American research participation in the Jackson Heart Study: methods, response rates, and sample description.Ethn Dis. 2005; 15(4Suppl 6):S6–18.
Oldenburg O, Lamp B, Horstkotte D. Cardiorespiratory screening for sleep-disordered breathing.Eur Respir J. 2006; 28:1065–1067. doi: 10.1183/09031936.00084406
7Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome.Eur Respir J. 2003; 21:253–259