Hypertension (HTN) affects one in three adults in the United States. HTN is considered resistant when blood pressure (BP) remains ≥ 140/90 mmHg. Drug-resistant high blood pressure (RHBP) is a common but severe clinical problem that predicts adverse cardiovascular events. Obstructive sleep apnea (OSA) is the most undiagnosed and untreated HTN co-morbidity, occurring in at least two-thirds of RHBP patients; yet, this clinically significant subgroup has not been widely studied. OSA treatment with continuous positive airway pressure (CPAP) likely improves blood pressure control, but evidence to support this assertion is conflicting and limited in the United States. The impact of CPAP on RHBP, especially among patients who receive chronic BP management at the community level, is poorly understood. Furthermore, whether demographic characteristics (e.g., ethnicity, age, sex), other co-morbidities (e.g., obesity, type 2 diabetes, dyslipidemia), or behavior (e.g., smoking, drinking, depression) play a role in the BP–OSA interaction remains largely unstudied.
We will partner with MultiCare’s Healthy Sleep and RHBP Support Groups, caregivers/spouses, sleep medicine/cardiovascular/occupational health/primary care physicians, commercial drivers, sleep medicine technicians, and nurses to build a comprehensive patient-engagement network. Through regular meetings and social media, we will discuss such issues as CPAP compliance, chronic condition management, co-morbidities, and barriers to risk modification, bringing in payers, device vendors, and researchers as appropriate. Patients with both RHBP and moderate-to-severe OSA will sit in the center of this research capacity–development effort. Our final goal is to submit a clinical comparative effectiveness research proposal that will generate a real-world pragmatic patient-centered outcomes research trial design incorporating input from all relevant stakeholders.