**Association between Hypertension and Stroke Recurrence as Modified by Pro-oxidant–Antioxidant Balance: A Multi-Center Study**

**Thu T. M. Pham 1,2, Tuyen Van Duong 3,\*, Lien T. K. Nguyen 4,5,6, Manh-Tan Vu 7,8, Khue M. Pham 2,9, Minh H. Nguyen 10, Thuc C. Luong 11,12, Binh N. Do 13,14, Lan T. H. Le 15,16,17, Nga H. Dang 15,18, Thao T. P. Nguyen 19, Hoang P. Le 20, Cuong Q. Tran 21,22, Kien T. Nguyen 23, Chaur-Jong Hu 24,25, Chang-Chuan Chan 26,27,28, Hui-Chuan Hsu <sup>1</sup> and Chyi-Huey Bai 1,\***

	- Hue 491-20, Vietnam; nguyenthiphuongthao@hueuni.edu.vn
	- <sup>20</sup> Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam; lephuochoang@hueuni.edu.vn
	- <sup>21</sup> Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam; quoccuong.mph@gmail.com
	- <sup>22</sup> Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
	- <sup>23</sup> Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam; ntk1@huph.edu.vn
	- <sup>24</sup> Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan; chaurjongh@tmu.edu.tw
	- <sup>25</sup> Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City 235-61, Taiwan

**Abstract:** Background: Hypertension and oxidative stress are involved in the pathophysiological mechanism of stroke. We aimed to investigate the modification impact of the pro-oxidant–antioxidant balance (PAB) on the association between hypertension and stroke recurrence (SR). Methods: A cross-sectional design was conducted from December 2019 to December 2020 in 951 stroke patients

**Citation:** Pham, T.T.M.; Duong, T.V.; Nguyen, L.T.K.; Vu, M.-T.; Pham, K.M.; Nguyen, M.H.; Luong, T.C.; Do, B.N.; Le, L.T.H.; Dang, N.H.; et al. Association between Hypertension and Stroke Recurrence as Modified by Pro-oxidant–Antioxidant Balance: A Multi-Center Study. *Nutrients* **2023**, *15*, 2305. https://doi.org/10.3390/ nu15102305

Academic Editors: Shane Phillips and Abeer M. Mahmoud

Received: 11 April 2023 Revised: 10 May 2023 Accepted: 12 May 2023 Published: 14 May 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

in six hospitals across Vietnam. Hypertension was defined using antihypertensive medication or systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. PAB was estimated using weighting methods based on smoking, drinking, and overweight/obesity with pro-oxidant capacity, diet quality, fruit intake, vegetable intake, and physical activity with antioxidant capacity. The higher PAB scores indicated a beneficial balance shifting toward antioxidant dominance. SR was diagnosed by neurologists. Moreover, sociodemographic and health conditions were included as covariates. Multiple logistic regression analyses were used to explore the associations and interactions. Results: The hypertension and SR proportions were 72.8% and 17.5%, respectively. hypertension was associated with an increased SR likelihood (odds ratio (OR) = 1.93; *p* = 0.004), whereas a higher PAB score was associated with a lowered SR likelihood (OR = 0.87; *p* = 0.003). Moreover, hypertension interacting with every one-point increment of PAB was associated with a lowered SR likelihood (OR = 0.83; *p* = 0.022). Conclusions: The harmful impact of hypertension on SR could be alleviated by PAB. The interplay of health behaviors should be highlighted in the intervention strategies for stroke prevention.

**Keywords:** stroke recurrence; hypertension; oxidative stress; pro-oxidant–antioxidant balance; health behavior
