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Relationship between Risks for OSA, Resistant Hypertension, and Aldosterone among African American Adults in the Jackson Heart Study.

BACKGROUND
African Americans have a higher prevalence of resistant hypertension compared to Caucasians. Racial differences in obstructive sleep apnea (OSA) and increased aldosterone level may explain the racial disparity in resistant hypertension prevalence. Therefore, the purpose of this study is to investigate if aldosterone level and hypertension status differ by risks for OSA (e.g. obesity, loud snoring, and daytime sleepiness) and how aldosterone level varies with hypertension severity and control among African Americans.


METHODS
A cross-sectional analysis was performed using baseline data on 5052 African-American adults in the Jackson Heart Study to investigate the relationships of interest using multivariable linear and multinomial logistic regression models adjusted for potential confounders. Risks for OSA was defined by a "risk score" consisting of the number of risks for OSA.


RESULTS
Of the 5052 participants, 623 had no risks for OSA. BMI was the highest among those with a risk score of 6. About 39% of the sample had no hypertension, 29% had controlled hypertension, 26% had uncontrolled hypertension, and 6% had resistant hypertension. Higher odds of having uncontrolled hypertension or resistant hypertension were present in those with a higher risk score compared to those without risks for OSA. Log-aldosterone level increased with each additional risk for OSA (p-trend <0.05). Similarly, log-aldosterone also increased with more severe hypertension (p-trend <0.001). The highest aldosterone level was found in those with resistant hypertension that was inadequately controlled with medications.


CONCLUSION
Risks for OSA were positively associated with resistant hypertension and higher aldosterone level in African-American adults.