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

Autor:	Radmanesh F; Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Division of Neurocritical Care, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA., Izzy S; 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., Rotem RS; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Tahir Z; Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA., Rademaker QJ; Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Yahya T; Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Mashlah A; Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Taylor HA Jr; Football Players Health Study at Harvard University, Boston, Massachusetts, USA.; Morehouse School of Medicine, Atlanta, Georgia, USA., Weisskopf MG; Football Players Health Study at Harvard University, Boston, Massachusetts, USA.; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Zafonte RD; Football Players Health Study at Harvard University, Boston, Massachusetts, USA.; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA., Baggish AL; Football Players Health Study at Harvard University, Boston, Massachusetts, USA.; Institute for Sport Science and Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Grashow R; Football Players Health Study at Harvard University, Boston, Massachusetts, USA.; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Neurotrauma reports [Neurotrauma Rep] 2024 Apr 22; Vol. 5 (1), pp. 462-466. Date of Electronic Publication: 2024 Apr 22 (Print Publication: 2024).
DOI:	10.1089/neur.2024.0015
Abstrakt:	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. Competing Interests: Zafonte: Springer/Demos Publishing, Myomo Inc., Onecare.ai Inc, MGH Brain and Body–TRUST Program/NFLPA; NIH. Baggish: NIH-NHLBI, NFLPA, AHA, US Olympic Committee/US Olympic Training Centers, US Soccer, US Rowing, NE Patriots, Boston Bruins, NE Revolution, and Harvard University. Taylor: NFLPA, NIH. Weisskopf: NFLPA, NIH. Izzy: McGraw Hill Education, NIH (5K08NS123503-02), and 2023 Stepping Strong Innovator Awards. (© Farid Radmanesh et al., 2024; Published by Mary Ann Liebert, Inc.)
Databáze:	MEDLINE
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