Socioeconomic status impacts blood pressure response to positive airway pressure treatment. Journal Article

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Authors: Imayama, I; Gupta, A; Yen, PS; Chen, YF; Keenan, B; Townsend, RR; Chirinos, JA; Weaver, FM; Carley, DW; Kuna, ST; Prasad, B
Article Title: Socioeconomic status impacts blood pressure response to positive airway pressure treatment.
Abstract: STUDY OBJECTIVES: Positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) reduces blood pressure (BP). Retrospective data suggest that African Americans (AA), a group at high-risk for hypertensive organ dysfunction, may have a greater BP response to PAP therapy than European Americans (EA). We examined the difference in 24-hour BP response to three months of PAP treatment between AA and EA. METHODS: Participants (N=259, 161 AA and 98 EA) with apnea-hypopnea index (AHI) =15/hour from two prospective cohorts were included. T-tests and multiple linear regression were used to examine BP outcomes in AA vs. EA, adjusting for PAP adherence, socioeconomic status (SES), and baseline characteristics. RESULTS: Participants were middle-aged (mean ± standard deviation, 53.8±9.3 years), 86% (227) men, AHI 35.6±19.2/hour, and PAP adherence of 3.36±2.24 hours/day. The reductions in 24-hour systolic and diastolic BP (mm Hg) were not different in AA vs. EA (systolic=-1.13±12.1 vs. -0.61±12.8, p=0.80 and diastolic=-0.74±7.9 vs. -0.80±7.4, p=0.96), and race was not a predictor of 24-hour systolic or diastolic BP reduction (p=0.75 and 0.54). SES and PAP adherence demonstrated a significant interaction; low SES was associated with an increase in 24-hour systolic BP (ß=19.3, p=0.03) in the absence of PAP use but a greater reduction in 24-hour systolic BP with higher PAP adherence (ß=-3.96, p=0.03). CONCLUSIONS: 24-hour BP response to PAP treatment is similar in AA and EA. Adherence to PAP treatment is more effective in improving 24-hour systolic BP in those with low SES. The study was a clinical trial. Clinical Trial Registration: NCT01960465 and NCT01578031.
Journal Title: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
ISSN: 1550-9397; 1550-9389
Publisher: Unknown  
Date Published: 2021