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Response by Sarfo to letter regarding “Patients with hypertension and/or diabetes and incident stroke: A risk assessment”

  • Fred S. Sarfo
    Correspondence
    Corresponding author at: Kwame Nkrumah University of Science & Technology, Department of Medicine, Neurology Division, Private Mail Bag, Kumasi, Ghana.
    Affiliations
    Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

    Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Published:December 12, 2018DOI:https://doi.org/10.1016/j.jns.2018.12.017
      We sincerely thank Dr. Kawada for his interest in our study titled ‘Incident stroke among Ghanaians with hypertension and diabetes: a multicenter, prospective study’. The aim of our study [
      • Sarfo F.S.
      • Mobula L.M.
      • Plange-Rhule J.
      • Ansong D.
      • Ofori-Adjei D.
      Incident stroke among Ghanaians with hypertension and diabetes: a multicenter, prospective cohort study.
      ] was to assess the rates and determinants of incident stroke among a prospective, hospital-based Ghanaian cohort with hypertension and or type 2 diabetes mellitus. In this regard, our study was not designed to “evaluate the risk of hypertension and diabetes for incident stroke” as specified by our correspondents. Rather, we sought to identify factors that increased the propensity for incident stroke among individuals who already had hypertension or diabetes. We found that physical inactivity and previous history of cigarette smoking were independently associated with stroke occurrence in this cohort. Stroke type information was not available, hence it was not possible to isolate the effect of risk factors for the primary ischemic or hemorrhagic stroke types which was recognized as a study limitation. We also accounted for sex in our model and found that although male sex was associated with a heightened risk of stroke occurrence with an unadjusted odds ratio of 2.10 (95% CI of 1.21–3.64), this effect size was attenuated into non-significance in our adjusted models. We found in sensitivity analysis that stage II hypertension was also independently associated with stroke occurrence. Indeed further re-analysis of this cohort has also shown that renal impairment is also associated with incident stroke occurrence [
      • Sarfo F.S.
      • Mobula L.M.
      • Sarfo-Kantanka O.
      • Adamu S.
      • Plange-Rhule J.
      • Ansong D.
      • et al.
      Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension.
      ].

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