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Brain & Heart Stroke risk in Nigerians with diabetes and hypertension

of Diseases, Tenth Revision, and Clinical Modification 2.6. Study size
diagnosis of cerebrovascular disease (I60-I69) during their The number of eligible patients identified from the patient
hospital stay. Due to limitations in the hospital and the records during the manual abstraction determines the
overall healthcare system of the country, brain computed sample size.
tomography or magnetic resonance imaging scans were not
available for all patients. Two members of the research team 2.7. Data analysis
separately analyzed the medical records of patients with a SPSS (version 30.0; IBM Corp., United State) for Windows
potential stroke diagnosis reached a consensus on the final was used for data analysis. Descriptive statistics with exact
diagnosis. A comprehensive medical history was gathered, confidence intervals were used to characterize the study
including the duration of HTN or diabetes diagnosis, along population and determine the proportion of patients
with the types and dosages of current medications. We also with acute stroke. Continuous variables were presented as
measured the following sociodemographic characteristics means with standard deviations, while categorical variables
of all enrolled patients, including age, sex, tribe, religion, were expressed as percentages. Unadjusted comparisons
marital status, and occupation.
were conducted using correlation and regression analyses.
2.4. Variables and diagnostic criteria The primary analysis examined the relationship between
HTN and stroke risk, as well as diabetes and stroke risk,
HTN was defined using the 2023 World Health employed bivariate analysis with Pearson’s correlation
Organization (WHO) criteria as repeated SBP readings coefficients. The primary analysis focused on stroke risk in
of 140 mmHg or higher, or DBP readings of 90 mmHg or three groups: Those with HTN, those with both diabetes
higher. We classified HTN based on the Seventh Report and HTN, and those with diabetes only. In the secondary
of the Joint National Committee 7 criteria: normal (SBP analysis, to compare the risk of stroke development among
<120 mmHg and DBP <80 mmHg); pre-HTN (SBP 120 the three cohorts, multiple correlation and regression
– 139 mmHg or DBP 80 – 89 mmHg); stage 1 (SBP 140 analyses were performed.
– 159 mmHg or DBP 90 – 99 mmHg); and stage 2 (SBP
≥160 mmHg or DBP ≥100 mmHg). The uncontrolled 3. Results
HTN was defined as repeated measurements of SBP
≥140 mmHg and DBP ≥90 mmHg, despite the use of 3.1. Hospital record search
antihypertensive medications. Diabetes was defined as We identified a total of 933 patient records by manual
fasting blood glucose concentration ≥126 mg/100 mL abstraction from hospital records, in which 517 records
(7 mmol/L). Stroke was diagnosed based on the WHO from Imam Wali Hospital and 416 from Imam Halliru
definition, encompassing sudden onset of unilateral Hospital. After screening and scrutinizing the hospital
weakness, sensory loss, vision loss, or speech impairment. records obtained from both hospitals, about 415 patient
Moreover, patients were categorized as physically active if records had missing information and therefore removed.
they engaged in moderate-intensity exercise (e.g., walking) The remaining 518 records were thoroughly reviewed, and
or vigorous-intensity exercise (e.g., jogging) for at least 318 records did not satisfy the inclusion and exclusion
4 h/week, or as not physically active. In addition, patients criteria and were thus excluded from the study. Therefore,
with a first-degree relative who had experienced a stroke only 200 records were included in the study, as they satisfied
were considered to have a family history of stroke. the eligibility criteria for stroke. A flowchart illustrating the
study selection process is depicted in Figure 1. During data
2.5. Risks of bias assessments abstraction, we noticed a serious poor data keeping in both
To minimize selection bias, a clearly defined population hospitals, which may explain the relatively small number
was used in the study, with the cohort recruited using a of patients included in the study over the 5-year period.
clearly defined method. Similarly, the selection of the
subjects was not related to the outcomes of interest. The 3.2. HTN cohort
average number of hospital visits was compared among From January 2015 through August 2020, there were
the three cohorts to minimize detection bias. All available 933 patients with outpatient visits at the two general
information within patient files was collected to minimize hospitals. This includes 200 patients with clinical features
information bias, and outcomes were accurately measured consistent with the WHO definition of stroke. Of the 200
using standard clinical criteria to minimize assessment possible stroke patients, 75 (37.5%) patients had HTN,
bias. Information on potential confounders like age, sex, constituting the hypertensive cohort. The age range of
poor medication compliance, and skipped hospital visits participants in this cohort was 35 – 85 years, with a mean
was carefully assessed. age of 61.96 ± 13.83 years. There were 56 (74.7%) females

Volume 3 Issue 1 (2025) 3 doi: 10.36922/bh.5722