249204 Resistant Hypertension and Sleep Apnea among Patients in the Primary-Care Setting

Monday, October 31, 2011

Keisha Ward , Department of Medicine, SUNY Downstate Medical School, Brooklyn, NY
Sidrah Mahmud , Department of Medicine, SUNY Downstate Medical School, Brooklyn, NY
Kaushal Kalra, MD , Brooklyn Health Disparities Center, SUNY Downstate Medical Center, Brooklyn, NY
Leah E. Robinson, PhD , Department of Kinesiology, Auburn University, Auburn, AL
Gloria Mtomboti, MD , Family Medicine department, SUNY Downstate Medical Center, Brooklyn, NY
Ferdinand Zizi, MBA , Clinical Instructor of Medicine and Neurology, Program Director, Brooklyn Health Disparities Center, SUNY Downstate Medical Center, Brooklyn, NY
Girardin Jean-Louis, PhD , Associate Professor of Medicine and Neurology, SUNY Downstate Medical Center, Brooklyn, NY
Introduction: This study ascertained the prevalence of Resistant Hypertension (RH) among black patients. It also determined whether patients with RH are at greater risk for Obstructive Sleep Apnea (OSA) than hypertensives.

Method: A total of 200 patients (mean age=6313 years; female=61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7 and European Society guidelines (uncontrolled BP despite treatment with 3 medications [including a diuretic] in suitable combination and recommended dosage). We assessed OSA risk using the Apnea Risk Evaluation System ARES, defining high risk as a total ARES score >=6. Patients provided informed consent under the supervision of the IRB at SUNY Downstate Medical Center. Analysis was performed with SPSS 18.0.

Results: Of the sample, 68% were diagnosed with diabetes, 83% dyslipidemia, 38% heart disease, and 11% stroke; 89% were overweight/obese. Average systolic and diastolic BP were 13519mmHg and 7511mmHg, respectively; blood glucose levels averaged 14564mg/dL, triglycerides 14785mg/dL, and LDL 9738mg/dL. Overall, 26% met criteria for RH, and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical comorbidity, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension [OR=2.46, 95%CI: 1.03-5.88, p<0.05].

Conclusion: Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3-29%). However, patients with RH were at significantly greater risk of OSA compared with patients with hypertension.

Learning Areas:
Administer health education strategies, interventions and programs
Advocacy for health and health education
Clinical medicine applied in public health
Epidemiology
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1.Discuss the importance of treating resistant hypertension among black patients in primary-care settings. 2.Assess public health consequences of untreated hypertension among patients with obstructive sleep apnea. 3.Identify resistant hypertensive patients for optimal screening and treatment of obstructive sleep apnea.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I have participated in all aspects of the abstract including design, collection, data analysis and final write-up.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.