%0 Journal Article
%T Resistant Hypertension and Obstructive Sleep Apnea in the Primary-Care Setting
%A M. Demede
%A A. Pandey
%A F. Zizi
%A R. Bachmann
%A M. Donat
%A S. I. McFarlane
%A G. Jean-Louis
%A G. Ogedegbe
%J International Journal of Hypertension
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/340929
%X We ascertained the prevalence of resistant hypertension (RH) among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA) than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO), a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ¡À 13 years; female = 61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES), defining high risk as a total ARES score ¡Ý6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, 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¨C5.88, . Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3¨C29%). However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension. 1. Introduction Resistant hypertension (RH) is defined as blood pressure that remains above goal (<140/90) in spite of concurrent use of three antihypertensive agents of different classes, one of which being a diuretic; all agents should be prescribed at optimal dosage amounts. Furthermore, observed blood pressure (BP) requiring ¡Ý4 medications to reach controlled BP should be considered resistant to treatment [1, 2]. Longitudinal studies and clinical trials have shown that RH is a common public health problem. Data from the ALLHAT trial indicated that the prevalence of resistant hypertension is 27% [3]. The Outpatient Quality Improvement Network¡¯s Hypertension Initiative, sampling primary-care clinics in South Carolina, North Carolina, and Georgia ( hypertensive patients), estimated that the overall prevalence of RH is about 16% [4]. Of note, 50% of the participants in both the National Health and Nutrition Examination Survey (NHANES) [5] and Framingham Heart Study [6] were able to reach a therapeutic goal of <140/ 90£¿mmHg. Those comprising the group who failed to reach the therapeutic goal likely included resistant hypertensives and pseudoresistant hypertensives. Given the increased trends in metabolic syndrome and obstructive sleep apnea (OSA), RH management will constitute a daunting task, with important social and economic ramifications. The
%U http://www.hindawi.com/journals/ijhy/2011/340929/