Factors Associated with Stroke Among Patients with Hypertension in Khong District, Nakhon Ratchasima Province

Abstract

            Stroke is a leading cause of death and disability among hypertensive patients, particularly in Khong District, Nakhon Ratchasima, where rates have consistently exceeded provincial averages. This study aimed to analyze factors associated with stroke and to develop a practical screening tool for primary care. Using an analytical cross-sectional design, 272 participants were enrolled (91 cases, 181 controls; ratio 1:2). Data from medical records and questionnaires were analyzed using multiple logistic regression with backward elimination. Model performance was evaluated through ROC analysis, Hosmer–Lemeshow goodness-of-fit, and Population Attributable Fraction (PAF).

            Multivariable analysis identified two independent factors: male sex (OR_adj = 2.41; 95% CI: 1.38, 4.20) and HbA1c above 8% (OR_adj = 3.60; 95% CI: 1.74, 7.48). BMI ≤ 25 kg/m² was not significant after adjustment (OR_adj = 1.66; p = 0.073), consistent with a "lean East-Asian phenotype" pattern. The model achieved AUC = 0.68 with good calibration. Joint stratification revealed a "super high-risk" subgroup: male patients with HbA1c above 8% had a stroke prevalence of 75.0% (OR = 10.17 versus reference). The PAF of HbA1c above 8% was 26.7%.

            Male sex and HbA1c above 8% are the most important independent risk factors for stroke in hypertensive patients. A simple 2-point risk score derived from these factors can be implemented at primary care to identify high-risk individuals. Stroke prevention should prioritize strict glycemic control and proactive monitoring of high-risk subgroups, rather than relying on health education alone.