Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension
Traumatic brain injury (TBI) is independently associated with hypertension and ischemic stroke. The goal of this study was to determine the interplay between TBI and incident hypertension in the occurrence of post-TBI stroke. This prospective study used a hospital-based registry to identify patients...
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| Format: | Article |
| Language: | English |
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Mary Ann Liebert
2024-11-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2024.0015 |
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| author | Farid Radmanesh Saef Izzy Ran S. Rotem Zabreen Tahir Quinn J. Rademaker Taha Yahya Ahmad Mashlah Herman A. Taylor Marc G. Weisskopf Ross D. Zafonte Aaron L. Baggish Rachel Grashow |
| author_facet | Farid Radmanesh Saef Izzy Ran S. Rotem Zabreen Tahir Quinn J. Rademaker Taha Yahya Ahmad Mashlah Herman A. Taylor Marc G. Weisskopf Ross D. Zafonte Aaron L. Baggish Rachel Grashow |
| author_sort | Farid Radmanesh |
| collection | DOAJ |
| description | Traumatic brain injury (TBI) is independently associated with hypertension and ischemic stroke. The goal of this study was to determine the interplay between TBI and incident hypertension in the occurrence of post-TBI stroke. This prospective study used a hospital-based registry to identify patients without pre-existing comorbidities. TBI patients (n = 3664) were frequency matched on age, sex, and race to non-TBI patients (n = 1848). Follow-up started 6 months post-TBI or study entry and extended up to 10 years. To examine hypertension's role in post-TBI stroke, we used logistic regression models to calculate the effect estimates for stroke in four exposure categories that included TBI or hypertension in isolation and in combination. Second, we calculated the conditional direct effect (CDE) of TBI in models that considered hypertension as intermediary. Third, we examined whether TBI effect was modified by antihypertensive medication use. The 10-year cumulative incidence of stroke was higher in the TBI group (4.7%) than the non-TBI group (1.3%; p < 0.001). TBI patients who developed hypertension had the highest risk of stroke (odds ratio [OR] = 4.83, 95% confidence interval [CI] = 2.53–9.23, p < 0.001). The combined effect estimates were less than additive, suggesting an overlapping biological pathway. The total effect of TBI (OR = 3.16, 95% CI = 1.94–5.16, p < 0.001) was higher than the CDE that accounted for hypertension (OR = 2.45, 95% CI = 0.93–6.47, p = 0.06). Antihypertensives attenuated the TBI effect, suggesting that the TBI effect on stroke is partially mediated through hypertension. TBI is an independent risk factor for long-term stroke, and the underlying biological pathway may partly operate through TBI-precipitated hypertension. These findings suggest that screening for hypertension may mitigate stroke risk in TBI. |
| format | Article |
| id | doaj-art-9af7b4342ba843cfbbaf2e30be40e288 |
| institution | Kabale University |
| issn | 2689-288X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Neurotrauma Reports |
| spelling | doaj-art-9af7b4342ba843cfbbaf2e30be40e2882025-08-20T03:49:37ZengMary Ann LiebertNeurotrauma Reports2689-288X2024-11-015146246610.1089/neur.2024.0015Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident HypertensionFarid Radmanesh0Saef Izzy1Ran S. Rotem2Zabreen Tahir3Quinn J. Rademaker4Taha Yahya5Ahmad Mashlah6Herman A. Taylor7Marc G. Weisskopf8Ross D. Zafonte9Aaron L. Baggish10Rachel Grashow11Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.Football Players Health Study at Harvard University, Boston, Massachusetts, USA.Football Players Health Study at Harvard University, Boston, Massachusetts, USA.Football Players Health Study at Harvard University, Boston, Massachusetts, USA.Football Players Health Study at Harvard University, Boston, Massachusetts, USA.Football Players Health Study at Harvard University, Boston, Massachusetts, USA.Traumatic brain injury (TBI) is independently associated with hypertension and ischemic stroke. The goal of this study was to determine the interplay between TBI and incident hypertension in the occurrence of post-TBI stroke. This prospective study used a hospital-based registry to identify patients without pre-existing comorbidities. TBI patients (n = 3664) were frequency matched on age, sex, and race to non-TBI patients (n = 1848). Follow-up started 6 months post-TBI or study entry and extended up to 10 years. To examine hypertension's role in post-TBI stroke, we used logistic regression models to calculate the effect estimates for stroke in four exposure categories that included TBI or hypertension in isolation and in combination. Second, we calculated the conditional direct effect (CDE) of TBI in models that considered hypertension as intermediary. Third, we examined whether TBI effect was modified by antihypertensive medication use. The 10-year cumulative incidence of stroke was higher in the TBI group (4.7%) than the non-TBI group (1.3%; p < 0.001). TBI patients who developed hypertension had the highest risk of stroke (odds ratio [OR] = 4.83, 95% confidence interval [CI] = 2.53–9.23, p < 0.001). The combined effect estimates were less than additive, suggesting an overlapping biological pathway. The total effect of TBI (OR = 3.16, 95% CI = 1.94–5.16, p < 0.001) was higher than the CDE that accounted for hypertension (OR = 2.45, 95% CI = 0.93–6.47, p = 0.06). Antihypertensives attenuated the TBI effect, suggesting that the TBI effect on stroke is partially mediated through hypertension. TBI is an independent risk factor for long-term stroke, and the underlying biological pathway may partly operate through TBI-precipitated hypertension. These findings suggest that screening for hypertension may mitigate stroke risk in TBI.https://www.liebertpub.com/doi/10.1089/neur.2024.0015hypertensionstroketraumatic brain injury |
| spellingShingle | Farid Radmanesh Saef Izzy Ran S. Rotem Zabreen Tahir Quinn J. Rademaker Taha Yahya Ahmad Mashlah Herman A. Taylor Marc G. Weisskopf Ross D. Zafonte Aaron L. Baggish Rachel Grashow Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension Neurotrauma Reports hypertension stroke traumatic brain injury |
| title | Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension |
| title_full | Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension |
| title_fullStr | Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension |
| title_full_unstemmed | Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension |
| title_short | Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension |
| title_sort | risk of long term ischemic stroke in patients with traumatic brain injury and incident hypertension |
| topic | hypertension stroke traumatic brain injury |
| url | https://www.liebertpub.com/doi/10.1089/neur.2024.0015 |
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