Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension

作者：Farid Radmanesh, Saef Izzy, Ran S. Rotem, Zabreen Tahir, Quinn Rademaker, Taha Yahya, Ahmad Mashlah, Herman A. Taylor, Marc G. Weisskopf, Ross Zafonte, Aaron L. Baggish, Rachel Grashow · 发表于：Neurotrauma Reports · 年份：2024 · DOI：10.1089/neur.2024.0015 · 被引用次数：3 · 研究领域：Traumatic Brain Injury and Neurovascular Disturbances、Cardiac Arrest and Resuscitation、Traumatic Brain Injury Research

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). ...